Provider Demographics
NPI:1821498403
Name:HOPE COUNSELING AND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:HOPE COUNSELING AND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW BCD
Authorized Official - Phone:570-402-1006
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:PA
Mailing Address - Zip Code:18331-0279
Mailing Address - Country:US
Mailing Address - Phone:570-402-1006
Mailing Address - Fax:610-681-8275
Practice Address - Street 1:1023 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:PA
Practice Address - Zip Code:18331-0279
Practice Address - Country:US
Practice Address - Phone:570-402-1006
Practice Address - Fax:610-681-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0132291041C0700X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011203100003Medicaid
PA083979OtherMEDICARE PTAN