Provider Demographics
NPI:1235320250
Name:TANDON, KATIE (LPC, CACD, CEAP, CCA)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:TANDON
Suffix:
Gender:F
Credentials:LPC, CACD, CEAP, CCA
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAME
Mailing Address - Street 1:36 MARIAN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2911
Mailing Address - Country:US
Mailing Address - Phone:610-917-0262
Mailing Address - Fax:
Practice Address - Street 1:832 GERMANTOWN PIKE STE 3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2442
Practice Address - Country:US
Practice Address - Phone:484-995-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACACD101YA0400X
PAPC003246101YM0800X
PACERTIFICATION103TC2200X
103TP2701X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist