Healthcare Provider Details

I. General information

NPI: 1588106181
Provider Name (Legal Business Name): FLORA CASALLAS, PSY.D, LPC, CADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600A W BROAD ST
QUAKERTOWN PA
18951-1284
US

IV. Provider business mailing address

615 COWPATH RD
HATFIELD PA
19440-2714
US

V. Phone/Fax

Practice location:
  • Phone: 215-715-5678
  • Fax: 267-893-5100
Mailing address:
  • Phone: 215-715-5678
  • Fax: 267-893-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StatePA

VIII. Authorized Official

Name: FLORA CASALLAS
Title or Position: CEO
Credential: PSYD, LPC, CADC
Phone: 215-715-5678