Provider Demographics
NPI:1922476639
Name:EXPERIENCE POSITIVE THERAPY, LLC
Entity Type:Organization
Organization Name:EXPERIENCE POSITIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:610-857-8089
Mailing Address - Street 1:4221 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-1780
Mailing Address - Country:US
Mailing Address - Phone:610-857-8089
Mailing Address - Fax:
Practice Address - Street 1:4221 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-1780
Practice Address - Country:US
Practice Address - Phone:610-857-8089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002613251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health