Provider Demographics
NPI:1164587002
Name:SAFE HARBOR COUNSELING CENTER
Entity Type:Organization
Organization Name:SAFE HARBOR COUNSELING CENTER
Other - Org Name:GENERAL COUNCIL OF THE ASSEMBLIES OF GOD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-833-8300
Mailing Address - Street 1:2032 E KEARNEY ST
Mailing Address - Street 2:STE 214
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4610
Mailing Address - Country:US
Mailing Address - Phone:417-833-8300
Mailing Address - Fax:417-869-1455
Practice Address - Street 1:2032 E KEARNEY ST
Practice Address - Street 2:STE 214
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4610
Practice Address - Country:US
Practice Address - Phone:417-833-8300
Practice Address - Fax:417-869-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty