Provider Demographics
NPI:1750153409
Name:EMILY ENDRES PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:EMILY ENDRES PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDRES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:672-253-5592
Mailing Address - Street 1:4708 CHESTER AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3762
Mailing Address - Country:US
Mailing Address - Phone:672-253-5592
Mailing Address - Fax:
Practice Address - Street 1:4708 CHESTER AVE APT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3762
Practice Address - Country:US
Practice Address - Phone:267-225-3559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health