Provider Demographics
NPI:1518737824
Name:DTAP MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DTAP MENTAL HEALTH SERVICES LLC
Other - Org Name:ELLIE PA-HAVERTOWN-TOWNSHIP LINE RD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CUBBAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:267-784-5118
Mailing Address - Street 1:8330 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7146
Mailing Address - Country:US
Mailing Address - Phone:267-784-5118
Mailing Address - Fax:
Practice Address - Street 1:1120 W TOWNSHIP LINE RD STE 101
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4930
Practice Address - Country:US
Practice Address - Phone:267-784-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health