=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639947591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGHT COUNSELING CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2023
-----------------------------------------------------
Last Update Date | 12/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 AIRPORT RD
-----------------------------------------------------
City | NEW HOLLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17557-9364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-889-2187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 SPRING HOLLOW DR
-----------------------------------------------------
City | NEW HOLLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17557-1460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-889-2187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC AND PRACTICE OWNER
-----------------------------------------------------
Name | DANIEL JENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-889-2187
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------