Provider Demographics
NPI:1225488190
Name:BEATRIX VON WATZDORF LLC
Entity Type:Organization
Organization Name:BEATRIX VON WATZDORF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIX
Authorized Official - Middle Name:
Authorized Official - Last Name:VON WATZDORF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:484-817-1220
Mailing Address - Street 1:2884 GALLOWS HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-9737
Mailing Address - Country:US
Mailing Address - Phone:484-817-1220
Mailing Address - Fax:
Practice Address - Street 1:2884 GALLOWS HILL RD
Practice Address - Street 2:
Practice Address - City:RIEGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18077-9737
Practice Address - Country:US
Practice Address - Phone:484-817-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty