Provider Demographics
NPI:1710524012
Name:DEMIURGE COUNSELING GROUP AND BEHAVIORAL HEALTH CONSULANTS LLC
Entity Type:Organization
Organization Name:DEMIURGE COUNSELING GROUP AND BEHAVIORAL HEALTH CONSULANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL SPECIALIST/PART OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ONIZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EL ALEEM BEY
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, LBSC
Authorized Official - Phone:267-847-2016
Mailing Address - Street 1:8215 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2403
Mailing Address - Country:US
Mailing Address - Phone:267-847-2016
Mailing Address - Fax:
Practice Address - Street 1:8215 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2403
Practice Address - Country:US
Practice Address - Phone:267-847-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty