Provider Demographics
NPI:1528547387
Name:WEST END COUNSELING & WELLNESS, LLC
Entity Type:Organization
Organization Name:WEST END COUNSELING & WELLNESS, LLC
Other - Org Name:LISA P COULTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-569-0252
Mailing Address - Street 1:1011 BROOKSIDE RD STE 122
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9020
Mailing Address - Country:US
Mailing Address - Phone:610-569-0252
Mailing Address - Fax:484-460-2470
Practice Address - Street 1:1011 BROOKSIDE RD STE 122
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9020
Practice Address - Country:US
Practice Address - Phone:610-569-0252
Practice Address - Fax:484-460-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036060860001Medicaid