Provider Demographics
NPI:1265823355
Name:HARVEST COUNSELING CENTER
Entity Type:Organization
Organization Name:HARVEST COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT IN COUNSELING
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIRACLE-LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:571-422-0056
Mailing Address - Street 1:7046 LEESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3518
Mailing Address - Country:US
Mailing Address - Phone:571-422-0056
Mailing Address - Fax:
Practice Address - Street 1:7046 LEESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3518
Practice Address - Country:US
Practice Address - Phone:571-422-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty