Provider Demographics
NPI:1932929908
Name:MEMORY LANE THERAPIES
Entity type:Organization
Organization Name:MEMORY LANE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:COX-HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:717-880-2563
Mailing Address - Street 1:441 E MARKET ST STE 2200B
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1618
Mailing Address - Country:US
Mailing Address - Phone:717-880-2563
Mailing Address - Fax:
Practice Address - Street 1:441 E MARKET ST STE 2200B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1618
Practice Address - Country:US
Practice Address - Phone:717-880-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)