NPIMap

Organization Active NPI

Safe Harbor Christian Counseling of Mid-Pennsylvania LLC

  • Psychologist
  • Harrisburg, PA
National Provider Identifier
1659626588
Registry record updated Feb 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS-005590-L Issued in PA
Legal business name
SAFE HARBOR CHRISTIAN COUNSELING OF MID-PENNSYLVANIA LLC
Practice address
5630 Devonshire Rd
Harrisburg, PA 17112-3911
Phone
(410) 569-9497
Fax
(410) 569-0094
NPI assigned
Jul 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce Weatherly, PSYNPI 1891040903
Title
Director
Phone
(814) 876-2938

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PS-005590-L PA Primary

Addresses

Primary practice location

5630 Devonshire Rd
Harrisburg, PA 17112-3911

Mailing address

344 S 13TH St
Harrisburg, PA 17104-1777
Phone (814) 876-2938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160211001298 PA Part B Supplier - Clinic/Group Practice 2163726126 Receives reassigned benefits from 3 practitioners
Practice locations: Bedford, PA; Lemoyne, PA; Mechanicsburg, PA; Shrewsbury, PA; West Chester, PA; York, PA; Altoona, PA

National Provider Directory

National Provider Directory

Locations

3220 Pleasant Valley Blvd
Ste 1
Altoona, PA 16602

9391 Lincoln Hwy
Bedford, PA 15522

5630 Devonshire Rd
Harrisburg, PA 17112
Phone (814) 876-2938

1775 Lambs Gap Rd
Mechanicsburg, PA 17050

1849 S Forge Rd
Palmyra, PA 17078

5 S Main St
Fl 2
Shrewsbury, PA 17361

8 S Main St
Shrewsbury, PA 17361

1215 Church Rd
York, PA 17404

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1659626588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 S 13TH ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041777",
            "telephone_number": "814-876-2938",
            "fax_number": "410-569-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5630 DEVONSHIRE RD",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171123911",
            "telephone_number": "410-569-9497",
            "fax_number": "410-569-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR CHRISTIAN COUNSELING OF MID-PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "WEATHERLY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "814-876-2938",
        "authorized_official_credential": "PSY"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS-005590-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.