=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588032056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOGOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2015
-----------------------------------------------------
Last Update Date | 09/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 WALNUT ST SUITE 305
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-606-5676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 WALNUT ST SUITE 305
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-606-5676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LINDSAY MARIE BAUER
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 267-606-5676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF00818
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------