Healthcare Provider Details

I. General information

NPI: 1003750498
Provider Name (Legal Business Name): TAHYNA JULES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E CITY AVE STE 859
BALA CYNWYD PA
19004-2421
US

IV. Provider business mailing address

117 W ABBOTTSFORD AVE
PHILADELPHIA PA
19144-3611
US

V. Phone/Fax

Practice location:
  • Phone: 610-467-7840
  • Fax:
Mailing address:
  • Phone: 706-504-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC019001
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: