Basic Information
| Provider Information | |||||||||
| NPI: | 1740201920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHOLOGICAL HEALTH AFFILIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 934 E CHOCOLATE AVE | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170331215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176652675 | ||||||||
| FaxNumber: | 7172560599 | ||||||||
| Practice Location | |||||||||
| Address1: | 934 E CHOCOLATE AVE | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170331215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176652675 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOSTLER | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | ROSEMARY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7176652675 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.