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General NPI Number Information
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NPI Number | 1932929908
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Entity Type | Organization
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Legal Business Name | MEMORY LANE THERAPIES
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 441 E MARKET ST STE 2200B
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City | YORK
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State | PA
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Zip | 17403-1618
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Country | US
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Telephone | 717-517-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 441 E MARKET ST STE 2200B
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City | YORK
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State | PA
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Zip | 17403-1618
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Country | US
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Telephone | 717-517-0417
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | GRAHAM ANDREW COX-HOLMES
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Credential | MA, LPC
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Telephone | 717-517-0417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 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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Taxonomy #3
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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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