Provider Demographics
NPI:1730727272
Name:HARBOR COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:HARBOR COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEELY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:ALC
Authorized Official - Phone:256-577-0217
Mailing Address - Street 1:519 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-6237
Mailing Address - Country:US
Mailing Address - Phone:256-577-0217
Mailing Address - Fax:
Practice Address - Street 1:5520 HIGHWAY 280 STE 4
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2308
Practice Address - Country:US
Practice Address - Phone:256-577-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL239201Medicaid