Healthcare Provider Details

I. General information

NPI: 1063343549
Provider Name (Legal Business Name): OWL INSIGHTS CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 WASHINGTON AVE
MEDIA PA
19063-3919
US

IV. Provider business mailing address

538 WASHINGTON AVE
MEDIA PA
19063-3919
US

V. Phone/Fax

Practice location:
  • Phone: 610-716-1136
  • Fax:
Mailing address:
  • Phone: 610-716-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MARLA SUZANNE MCCULLOCH
Title or Position: THERAPIST
Credential: LCSW
Phone: 610-716-1136