Provider Demographics
NPI:1477309250
Name:THERAPEUTIC SERVICES, LIVING SUPPORT AND COMMUNITY WELLNESS (TLC)
Entity type:Organization
Organization Name:THERAPEUTIC SERVICES, LIVING SUPPORT AND COMMUNITY WELLNESS (TLC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-923-8035
Mailing Address - Street 1:3500 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-5732
Mailing Address - Country:US
Mailing Address - Phone:724-923-8035
Mailing Address - Fax:
Practice Address - Street 1:301 S MILL ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4002
Practice Address - Country:US
Practice Address - Phone:724-923-8035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health