Provider Demographics
NPI:1679045967
Name:BLUE OASIS THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:BLUE OASIS THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANESSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS NCC LPC
Authorized Official - Phone:484-273-2361
Mailing Address - Street 1:2365 HAHNS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-5322
Mailing Address - Country:US
Mailing Address - Phone:484-464-1964
Mailing Address - Fax:
Practice Address - Street 1:2233 WALBERT AVE STE 202
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1363
Practice Address - Country:US
Practice Address - Phone:484-273-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty