Provider Demographics
NPI:1568932085
Name:WELL TIED KNOT LLC
Entity Type:Organization
Organization Name:WELL TIED KNOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:202-258-1600
Mailing Address - Street 1:3805 DAVIS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-8740
Mailing Address - Country:US
Mailing Address - Phone:202-258-1600
Mailing Address - Fax:
Practice Address - Street 1:6703 GERMANTOWN AVE # 210-3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2109
Practice Address - Country:US
Practice Address - Phone:215-606-3414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)