Healthcare Provider Details

I. General information

NPI: 1972374973
Provider Name (Legal Business Name): YORK TMS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 SOUTH QUEEN STREET
YORK PA
17403-3852
US

IV. Provider business mailing address

1493 SOUTH QUEEN STREET
YORK PA
17403-3852
US

V. Phone/Fax

Practice location:
  • Phone: 717-430-0434
  • Fax: 717-854-0242
Mailing address:
  • Phone: 717-430-0434
  • Fax: 717-854-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: GRACIA ETIENNE
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 717-430-0434