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Organization
THERAPY BASED LTD
Active
Organization
THERAPY BASED LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE MARCUS GILLIAM LPC, NCC (LICENSED PROFESSIONAL COUNSELOR)
(215) 839-6867
Entity
Organization
Contact information
Practice address
4049 HAVERFORD AVE FL 2, PHILADELPHIA, PA 19104-1745
(215) 839-6867
Mailing address
4049 HAVERFORD AVE FL 2, PHILADELPHIA, PA 19104-1745
(215) 839-6867
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
08/31/2023
Last updated
06/10/2026
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