Provider Demographics
NPI:1578787057
Name:CHILD GUIDANCE RESOURCE CENTERS
Entity Type:Organization
Organization Name:CHILD GUIDANCE RESOURCE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEADOWS-MARTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:484-454-8700
Mailing Address - Street 1:2000 OLD WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2712
Mailing Address - Country:US
Mailing Address - Phone:484-454-8735
Mailing Address - Fax:484-454-8706
Practice Address - Street 1:744 E LINCOLN HWY
Practice Address - Street 2:SUITE 420
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320
Practice Address - Country:US
Practice Address - Phone:484-454-8734
Practice Address - Fax:484-454-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA112610251B00000X, 251S00000X
PA184890261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112610Medicaid
PA184890Medicaid