Healthcare Provider Details

I. General information

NPI: 1275257404
Provider Name (Legal Business Name): WHOLE HEART INTEGRATIVE COUNSELING PSYCHOTHERAPY AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 LANCASTER PIKE 1ST FLOOR PMB # 7455
READING PA
19607
US

IV. Provider business mailing address

2395 LANCASTER PIKE 1ST FLOOR PMB # 7455
READING PA
19607
US

V. Phone/Fax

Practice location:
  • Phone: 862-268-9000
  • Fax:
Mailing address:
  • Phone: 862-268-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. PERLA BASTIEN-LARIVAUX
Title or Position: OWNER/ADMINISTRATOR
Credential: MA, LPC
Phone: 862-268-9000