Provider Demographics
NPI:1821120619
Name:HARVEY HAACK
Entity Type:Organization
Organization Name:HARVEY HAACK
Other - Org Name:MISSION NEW LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, CACD
Authorized Official - Phone:717-329-4178
Mailing Address - Street 1:39 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3946
Mailing Address - Country:US
Mailing Address - Phone:717-394-5495
Mailing Address - Fax:717-533-6071
Practice Address - Street 1:39 W VINE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3946
Practice Address - Country:US
Practice Address - Phone:717-394-5495
Practice Address - Fax:717-533-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA367079251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health