Healthcare Provider Details

I. General information

NPI: 1346904364
Provider Name (Legal Business Name): THE HARBOR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S MILL AVE STE 5
TEMPE AZ
85282-6736
US

IV. Provider business mailing address

675 S ROOSEVELT ST STE 3005
TEMPE AZ
85281-3697
US

V. Phone/Fax

Practice location:
  • Phone: 614-705-3044
  • Fax:
Mailing address:
  • Phone: 602-567-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN MEYER
Title or Position: OWNER
Credential: LPC
Phone: 602-567-7895