Provider Demographics
NPI:1891173126
Name:GESTALT DEVELOPMENT CENTER, LLC
Entity Type:Organization
Organization Name:GESTALT DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-244-0501
Mailing Address - Street 1:2023 N 2ND ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2151
Mailing Address - Country:US
Mailing Address - Phone:814-244-0501
Mailing Address - Fax:717-695-9520
Practice Address - Street 1:2023 N 2ND ST
Practice Address - Street 2:SUITE 111
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-2151
Practice Address - Country:US
Practice Address - Phone:814-244-0501
Practice Address - Fax:717-695-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006696251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health