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General NPI Number Information
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NPI Number | 1467901793
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Entity Type | Organization
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Legal Business Name | MENTAL BALANCE- COGNITIVE BEHAVIORAL THERAPY
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 119 HARRY ST FIRST FLOOR
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1821
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Country | US
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Telephone | 610-529-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 7404 HENRY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1402
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Country | US
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Telephone | 610-529-0936
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | VANESSA MCALLISTER
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Credential | LPC
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Telephone | 610-529-0936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PC005784
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License Number State | PA
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