Provider Demographics
NPI:1215524780
Name:LIFESOURCE COUNSELING AND EDUCATION CENTER, LLC
Entity type:Organization
Organization Name:LIFESOURCE COUNSELING AND EDUCATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, MED, MS, LPC
Authorized Official - Phone:610-573-6177
Mailing Address - Street 1:2605 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1818
Mailing Address - Country:US
Mailing Address - Phone:267-817-7511
Mailing Address - Fax:
Practice Address - Street 1:2605 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1818
Practice Address - Country:US
Practice Address - Phone:267-817-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)