Provider Demographics
NPI:1861572323
Name:SAFETY NET COUNSELING, INC
Entity type:Organization
Organization Name:SAFETY NET COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-339-1119
Mailing Address - Street 1:100 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1342
Mailing Address - Country:US
Mailing Address - Phone:570-339-1119
Mailing Address - Fax:570-339-2824
Practice Address - Street 1:100 N VINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1342
Practice Address - Country:US
Practice Address - Phone:570-339-1119
Practice Address - Fax:570-339-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA309920261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100733684Medicaid