Provider Demographics
NPI:1023386117
Name:GLAD SERVICES COUNSELING AND COACHING CENTER
Entity Type:Organization
Organization Name:GLAD SERVICES COUNSELING AND COACHING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DERRER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:610-678-7300
Mailing Address - Street 1:1110 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1151
Mailing Address - Country:US
Mailing Address - Phone:610-678-7300
Mailing Address - Fax:610-678-3698
Practice Address - Street 1:4 WELLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1850
Practice Address - Country:US
Practice Address - Phone:610-678-0266
Practice Address - Fax:610-678-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty