MEDICARE: SAFE HARBOR COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1164587002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR COUNSELING CENTER

Provider Business Mailing Address
First Line	:	2032 E KEARNEY ST
Second Line	:	STE 214
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-4610
Country	:	US
Telephone Number	:	417-833-8300
Fax Number	:	417-869-1455

Provider Business Practice Location Address
First Line	:	2032 E KEARNEY ST
Second Line	:	STE 214
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-4610
Country	:	US
Telephone Number	:	417-833-8300
Fax Number	:	417-869-1455

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TIMOTHY P LYONS
Credential	:	LPC
Telephone Number	:	417-833-8300

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	09/11/2025

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