Provider Demographics
NPI:1659649911
Name:ASSOCIATES IN BEHAVIORAL DIAGNOSTICS AND TREATMENT, LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN BEHAVIORAL DIAGNOSTICS AND TREATMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:412-329-7778
Mailing Address - Street 1:1150 THORN RUN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 THORN RUN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-3102
Practice Address - Country:US
Practice Address - Phone:412-329-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101728769Medicaid