Healthcare Provider Details

I. General information

NPI: 1477309250
Provider Name (Legal Business Name): THERAPEUTIC SERVICES, LIVING SUPPORT AND COMMUNITY WELLNESS (TLC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MILL ST
NEW CASTLE PA
16101-4002
US

IV. Provider business mailing address

3500 MITCHELL RD
NEW CASTLE PA
16105-5732
US

V. Phone/Fax

Practice location:
  • Phone: 724-923-8035
  • Fax:
Mailing address:
  • Phone: 724-923-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GAYLE WILKES
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 724-923-8035