Provider Demographics
NPI:1265171912
Name:SPLAWN, THALIA
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:SPLAWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 FAIRFIELD RD # SITEF
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-6309
Mailing Address - Country:US
Mailing Address - Phone:717-398-2044
Mailing Address - Fax:
Practice Address - Street 1:2311 FAIRFIELD RD # SITEF
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-6309
Practice Address - Country:US
Practice Address - Phone:717-398-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00000000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health