| Kidspeace Outpatient Mental Health Clinic | |
|
451 W. Chew St. Suite 105 Allentown PA 18102 | |
| (610) 776-5465 | |
| (610) 663-3270 |
| Full Name | Kidspeace Outpatient Mental Health Clinic |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 451 W. Chew St., Allentown, Pennsylvania |
| Authorized Official Name and Position | Michael W Slack (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 6107998525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidspeace Outpatient Mental Health Clinic Kidspeace Corporation 4085 Independence Dr Schnecksville PA 18078 Ph: (610) 799-8525 | Kidspeace Outpatient Mental Health Clinic 451 W. Chew St. Suite 105 Allentown PA 18102 Ph: (610) 776-5465 |
| NPI Number | 1740688423 |
|---|---|
| Provider Enumeration Date | 12/12/2014 |
| Last Update Date | 03/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740688423 | NPI | - | NPPES |
| 1007283700027 | Medicaid | PA | |
| 100728370-0016 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 218750 (Pennsylvania) | Primary |
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