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General NPI Number Information
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NPI Number | 1568932085
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Entity Type | Organization
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Legal Business Name | WELL TIED KNOT LLC
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 6703 GERMANTOWN AVE # 210-3
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2109
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Country | US
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Telephone | 215-606-3414
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Fax |
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Provider Business Mailing Address
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Address Line | 3805 DAVIS CT
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City | CHESTER SPRINGS
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State | PA
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Zip | 19425-8740
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Country | US
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Telephone | 202-258-1600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE S KAGEL
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Credential | LMFT
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Telephone | 202-258-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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