Healthcare Provider Details

I. General information

NPI: 1386304814
Provider Name (Legal Business Name): CELTIC MYST COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2021
Last Update Date: 12/24/2021
Certification Date: 12/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 CORNING RD
ZIONSVILLE PA
18092-2322
US

IV. Provider business mailing address

7815 CORNING RD
ZIONSVILLE PA
18092-2322
US

V. Phone/Fax

Practice location:
  • Phone: 215-613-0043
  • Fax: 610-628-9691
Mailing address:
  • Phone: 215-613-0043
  • Fax: 610-628-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA ANNE KULP
Title or Position: MANAGING DIRECTOR
Credential: LCSW
Phone: 215-613-0043