Basic Information
| Provider Information | |||||||||
| NPI: | 1366530305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENTAL HEALTH ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1880 AUGUST DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190061511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153962720 | ||||||||
| FaxNumber: | 2153968822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1880 AUGUST DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190061511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153962720 | ||||||||
| FaxNumber: | 2153968822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KELL | ||||||||
| AuthorizedOfficialFirstName: | NELSON | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2153962720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.ED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS005817L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | ME693170 | 01 | PA | PA BLUE SHIELD | OTHER |