Provider Demographics
NPI:1750862280
Name:MINOR, ALLISHA MARIE (MAMFT)
Entity Type:Individual
Prefix:
First Name:ALLISHA
Middle Name:MARIE
Last Name:MINOR
Suffix:
Gender:F
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1604
Mailing Address - Country:US
Mailing Address - Phone:267-239-6447
Mailing Address - Fax:
Practice Address - Street 1:2 BALA PLZ STE 300
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1512
Practice Address - Country:US
Practice Address - Phone:267-517-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty