Healthcare Provider Details

I. General information

NPI: 1619537354
Provider Name (Legal Business Name): VILLAGE THERAPY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 06/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VILLAGE RD STE 2
HORSHAM PA
19044-3816
US

IV. Provider business mailing address

2 VILLAGE RD STE 2
HORSHAM PA
19044-3816
US

V. Phone/Fax

Practice location:
  • Phone: 215-582-9086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JILL PALME
Title or Position: ADMINISTRATOR
Credential: LPC, NCC, MED
Phone: 215-582-9086