Provider Demographics
NPI:1336528744
Name:TAG INSPIRES
Entity Type:Organization
Organization Name:TAG INSPIRES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANIEK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENTLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:718-974-7885
Mailing Address - Street 1:1810 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2626
Mailing Address - Country:US
Mailing Address - Phone:718-974-7885
Mailing Address - Fax:215-242-2051
Practice Address - Street 1:309 W GLENSIDE AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-3313
Practice Address - Country:US
Practice Address - Phone:215-558-5616
Practice Address - Fax:215-242-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty