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General NPI Number Information
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NPI Number | 1164839312
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Entity Type | Organization
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Legal Business Name | THE OPENING PATH
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 313 WEST LIBERTY STREET SUITE 230
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City | LANCASTER
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State | PA
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Zip | 17603
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Country | US
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Telephone | 717-538-0161
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Fax | 717-427-1112
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Provider Business Mailing Address
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Address Line | 313 WEST LIBERTY STREET SUITE 230
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City | LANCASTER
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State | PA
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Zip | 17603
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Country | US
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Telephone | 717-538-0161
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Fax | 717-427-1112
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Authorized Official
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Title or Position | DIRECTOR OF CORPORATE OPERATIONS
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Name | URSULA JOAN WANNER
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Credential | MS, MDIV
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Telephone | 717-538-0161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS009042L
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License Number State | PA
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