Provider Demographics
NPI:1902420425
Name:FALWELL, HARRY SHANE
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:SHANE
Last Name:FALWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4323
Mailing Address - Country:US
Mailing Address - Phone:484-840-6929
Mailing Address - Fax:
Practice Address - Street 1:2203 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4323
Practice Address - Country:US
Practice Address - Phone:484-840-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172A00000XOther Service ProvidersDriver
No174400000XOther Service ProvidersSpecialist