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General NPI Number Information
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NPI Number | 1588403653
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Entity Type | Organization
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Legal Business Name | ECLECTIC COUNSELING THERAPEUTICS
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1346 N 27TH ST FL 3
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City | PHILADELPHIA
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State | PA
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Zip | 19121-4672
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Country | US
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Telephone | 347-479-9333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 238
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City | SOMERDALE
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State | NJ
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Zip | 08083-0238
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LPC
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Name | MICHAEL TYLER
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Credential | MD
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Telephone | 347-479-9333
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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 |
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License Number State |
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