Organization
TAG INSPIRES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANIEK A GENTLES LMFT (EXECUTIVE DIRECTOR)
(718) 974-7885
Entity
Organization
Contact information
Practice address
309 W GLENSIDE AVE, GLENSIDE, PA 19038-3313
(215) 558-5616
(215) 242-2051
Mailing address
1810 68TH AVE, PHILADELPHIA, PA 19126-2626
(718) 974-7885
(215) 242-2051
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MF000813
PA
Other
Enumeration date
05/19/2015
Last updated
05/19/2015
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