Healthcare Provider Details

I. General information

NPI: 1457386328
Provider Name (Legal Business Name): METHODIST SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MARKET ST
BANGOR PA
18013-1901
US

IV. Provider business mailing address

4300 MONUMENT RD
PHILADELPHIA PA
19131-1616
US

V. Phone/Fax

Practice location:
  • Phone: 610-588-9109
  • Fax: 610-588-5016
Mailing address:
  • Phone: 215-877-1925
  • Fax: 215-877-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANITA HOWARD
Title or Position: ADMINISTRATOR OF GRANTS AND CONTRAC
Credential:
Phone: 215-877-1925