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General NPI Number Information
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NPI Number | 1760644744
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA MENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1235 PINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5945
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Country | US
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Telephone | 215-735-9379
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Fax | 215-735-8806
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Provider Business Mailing Address
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Address Line | 1235 PINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5945
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Country | US
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Telephone | 215-735-9379
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Fax | 215-735-8806
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Authorized Official
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Title or Position | DIRECTOR BILLING/PC SYSTEMS
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Name | MR. ALLEN ANDERSON
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Credential |
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Telephone | 215-735-5674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 123880
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License Number State | PA
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