Provider Demographics
NPI:1932309226
Name:HARVARD COUNSELING CENTER
Entity Type:Organization
Organization Name:HARVARD COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:FORTIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-464-4900
Mailing Address - Street 1:1813 W HARVARD AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2752
Mailing Address - Country:US
Mailing Address - Phone:541-464-4900
Mailing Address - Fax:541-464-4577
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2752
Practice Address - Country:US
Practice Address - Phone:541-464-4900
Practice Address - Fax:541-464-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL2416251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health