Healthcare Provider Details

I. General information

NPI: 1104571975
Provider Name (Legal Business Name): EMMALENA KHOUREY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 FERNON ST
PHILADELPHIA PA
19145-1406
US

IV. Provider business mailing address

1725 FERNON ST
PHILADELPHIA PA
19145-1406
US

V. Phone/Fax

Practice location:
  • Phone: 304-650-9875
  • Fax:
Mailing address:
  • Phone: 304-650-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC013820
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: