Healthcare Provider Details

I. General information

NPI: 1659649911
Provider Name (Legal Business Name): ASSOCIATES IN BEHAVIORAL DIAGNOSTICS AND TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 THORN RUN RD SUITE 110
MOON TWP PA
15108-3102
US

IV. Provider business mailing address

1150 THORN RUN RD SUITE 110
MOON TWP PA
15108-3102
US

V. Phone/Fax

Practice location:
  • Phone: 412-329-7778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA PELPHREY
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 412-329-7778