Healthcare Provider Details

I. General information

NPI: 1972555605
Provider Name (Legal Business Name): PHILMONT GUIDANCE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WELSH RD SUITE 202
HUNTINGDON VALLEY PA
19006-6357
US

IV. Provider business mailing address

727 WELSH RD SUITE 202
HUNTINGDON VALLEY PA
19006-6357
US

V. Phone/Fax

Practice location:
  • Phone: 215-914-2119
  • Fax: 215-914-2289
Mailing address:
  • Phone: 215-914-2119
  • Fax: 215-914-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD042439L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier038548N5M
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPTAN

VIII. Authorized Official

Name: KIMBERLY A BOWERS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 215-914-2119