Provider Demographics
NPI:1982910204
Name:ADVANCED BEHAVIORAL COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-741-0390
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:SUITE 302 A
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2264
Mailing Address - Country:US
Mailing Address - Phone:609-741-0390
Mailing Address - Fax:609-241-2811
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:SUITE 302 A
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2264
Practice Address - Country:US
Practice Address - Phone:609-741-0390
Practice Address - Fax:609-241-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB05713400261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ770565Medicare PIN