Provider Demographics
NPI:1659992907
Name:HORACEK-KUNKLE, MARIKA SIAN (ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:SIAN
Last Name:HORACEK-KUNKLE
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 EARL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1949
Mailing Address - Country:US
Mailing Address - Phone:917-913-6174
Mailing Address - Fax:
Practice Address - Street 1:122 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1881
Practice Address - Country:US
Practice Address - Phone:484-509-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17-132221700000X
PAPC012189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty