Provider Demographics
NPI:1013329416
Name:WATERSHED FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:WATERSHED FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWDECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-389-9683
Mailing Address - Street 1:2916 HENLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-7140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 TWINING RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1831
Practice Address - Country:US
Practice Address - Phone:610-389-9683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty