Healthcare Provider Details

I. General information

NPI: 1730566753
Provider Name (Legal Business Name): ANTONIA PROUTEY MHS LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S COMMERCE WAY STE 300
BETHLEHEM PA
18017-8611
US

IV. Provider business mailing address

90 S COMMERCE WAY STE 300
BETHLEHEM PA
18017-8611
US

V. Phone/Fax

Practice location:
  • Phone: 610-691-8401
  • Fax: 610-691-0647
Mailing address:
  • Phone: 610-691-8401
  • Fax: 610-691-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBH002171
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002171
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: