Healthcare Provider Details

I. General information

NPI: 1023820545
Provider Name (Legal Business Name): LAURA TJARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N PARK RD
WYOMISSING PA
19610-1342
US

IV. Provider business mailing address

115 TELFORD AVE
READING PA
19609-1629
US

V. Phone/Fax

Practice location:
  • Phone: 484-709-1381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018130
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: