Provider Demographics
NPI:1538598842
Name:HARLAN COUNSELING, PSC
Entity type:Organization
Organization Name:HARLAN COUNSELING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:SAWAF
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-273-5359
Mailing Address - Street 1:2415 W HIGHWAY 72
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-7077
Mailing Address - Country:US
Mailing Address - Phone:606-273-5359
Mailing Address - Fax:606-573-8321
Practice Address - Street 1:2415 W HIGHWAY 72
Practice Address - Street 2:SUITE 203
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-7077
Practice Address - Country:US
Practice Address - Phone:606-273-5359
Practice Address - Fax:606-573-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30613038Medicaid