Provider Demographics
NPI:1407341787
Name:NEW HARVEST THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:NEW HARVEST THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NANOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:219-852-8558
Mailing Address - Street 1:PO BOX 3294
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0294
Mailing Address - Country:US
Mailing Address - Phone:219-852-8558
Mailing Address - Fax:219-852-8558
Practice Address - Street 1:8124 CALUMET AVE STE B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:317-840-8963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043103A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)