Provider Demographics
NPI:1427612175
Name:RICHLAND COUNSELING CENTER LLC
Entity type:Organization
Organization Name:RICHLAND COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:BREVOORT
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-643-3011
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-0049
Mailing Address - Country:US
Mailing Address - Phone:215-643-3011
Mailing Address - Fax:
Practice Address - Street 1:200 APPLE ST STE 4
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1645
Practice Address - Country:US
Practice Address - Phone:215-858-1674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043388762OtherANN B TUCKER NPI
488136000OtherIBX
5386083OtherAETNA
PAPS-008240-LOtherPA LICENSE
1664450OtherBEACON
247500000OtherMAGELLAN