Healthcare Provider Details

I. General information

NPI: 1104421312
Provider Name (Legal Business Name): AMAVI THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 S MAIN ST STE B2
YARDLEY PA
19067-1526
US

IV. Provider business mailing address

19 S MAIN ST STE B2
YARDLEY PA
19067-1526
US

V. Phone/Fax

Practice location:
  • Phone: 267-726-4831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JANIKA VEASLEY
Title or Position: OWNER
Credential: LMFT
Phone: 267-726-4831