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General NPI Number Information
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NPI Number | 1760254650
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Entity Type | Organization
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Legal Business Name | EMOTIONALLY REWIRED, LLC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 25 E BRIDGE ST
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City | MORRISVILLE
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State | PA
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Zip | 19067-7129
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Country | US
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Telephone | 267-797-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 115 LIBERTY ST
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City | NEWTOWN
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State | PA
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Zip | 18940-2024
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Country | US
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Telephone | 267-577-1155
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Fax |
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Authorized Official
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Title or Position | FOUNDER/LICENSED CMH COUNSELOR
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Name | MELISSA ANNE TATAR-PICKERSGILL
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Credential | MS, LPC, NCC
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Telephone | 267-577-1155
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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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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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