Provider Demographics
NPI:1659626588
Name:SAFE HARBOR CHRISTIAN COUNSELING OF MID-PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:SAFE HARBOR CHRISTIAN COUNSELING OF MID-PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
Authorized Official - Phone:814-876-2938
Mailing Address - Street 1:344 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1777
Mailing Address - Country:US
Mailing Address - Phone:814-876-2938
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:5630 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3911
Practice Address - Country:US
Practice Address - Phone:410-569-9497
Practice Address - Fax:410-569-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005590-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty