Provider Demographics
NPI:1720845217
Name:PRISM THERAPY CENTER LLC
Entity Type:Organization
Organization Name:PRISM THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:267-627-0177
Mailing Address - Street 1:127 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3530
Mailing Address - Country:US
Mailing Address - Phone:267-627-0177
Mailing Address - Fax:
Practice Address - Street 1:101 GREENWOOD AVE STE 625
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2686
Practice Address - Country:US
Practice Address - Phone:267-627-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty