Provider Demographics
NPI:1780363135
Name:IDELL, KATHRYN E (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:IDELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:IDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:11 W TULPEHOCKEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2607
Mailing Address - Country:US
Mailing Address - Phone:215-589-8601
Mailing Address - Fax:
Practice Address - Street 1:1260 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2013
Practice Address - Country:US
Practice Address - Phone:267-585-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional