Provider Demographics
NPI:1952804023
Name:FURNACE CREEK COUNSELING LLC
Entity Type:Organization
Organization Name:FURNACE CREEK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:610-750-9135
Mailing Address - Street 1:2966 LINDA LANE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608
Mailing Address - Country:US
Mailing Address - Phone:610-750-9135
Mailing Address - Fax:610-750-9135
Practice Address - Street 1:509 W PENN AVE.
Practice Address - Street 2:UNIT 10
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551
Practice Address - Country:US
Practice Address - Phone:610-750-9135
Practice Address - Fax:610-750-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006184101YP2500X
PAPC003093101YP2500X
PACW0159671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty