Provider Demographics
NPI:1659006385
Name:LILAC THERAPY CENTER LLC
Entity Type:Organization
Organization Name:LILAC THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALORA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-763-1651
Mailing Address - Street 1:748 N BETHLEHEM PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2652
Mailing Address - Country:US
Mailing Address - Phone:610-763-1651
Mailing Address - Fax:
Practice Address - Street 1:748 N BETHLEHEM PIKE STE 104
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2652
Practice Address - Country:US
Practice Address - Phone:610-763-1651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)