=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366530305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL HEALTH ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 AUGUST DR
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-396-2720
-----------------------------------------------------
Fax | 215-396-8822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1880 AUGUST DR
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-396-2720
-----------------------------------------------------
Fax | 215-396-8822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | NELSON A. KELL
-----------------------------------------------------
Credential | M.ED
-----------------------------------------------------
Telephone | 215-396-2720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS005817L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------