Provider Demographics
NPI:1588106181
Name:FLORA CASALLAS, PSY.D, LPC, CADC
Entity type:Organization
Organization Name:FLORA CASALLAS, PSY.D, LPC, CADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC, CADC
Authorized Official - Phone:215-715-5678
Mailing Address - Street 1:615 COWPATH RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2714
Mailing Address - Country:US
Mailing Address - Phone:215-715-5678
Mailing Address - Fax:267-893-5100
Practice Address - Street 1:600A W BROAD ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1284
Practice Address - Country:US
Practice Address - Phone:215-715-5678
Practice Address - Fax:267-893-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QM0850X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health