Healthcare Provider Details

I. General information

NPI: 1992576904
Provider Name (Legal Business Name): TLK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 COWAN RD
PARKESBURG PA
19365-2109
US

IV. Provider business mailing address

108 TYLER DR
COATESVILLE PA
19320-5523
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-9487
  • Fax:
Mailing address:
  • Phone: 302-428-9487
  • Fax: 484-786-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEY L KENWORTHY
Title or Position: LICENSED PSYCHOLOGIST/CEO
Credential: PHD
Phone: 484-467-5991