Provider Demographics
NPI:1154583839
Name:SAFE HARBOR FOUNDATION
Entity type:Organization
Organization Name:SAFE HARBOR FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SOARING EAGLE
Authorized Official - Last Name:VONDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:8886-132-2656
Mailing Address - Street 1:801 FLANAGAN RD
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-4965
Mailing Address - Country:US
Mailing Address - Phone:888-613-2266
Mailing Address - Fax:888-613-2266
Practice Address - Street 1:801 FLANAGAN RD
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-4965
Practice Address - Country:US
Practice Address - Phone:888-613-2266
Practice Address - Fax:888-613-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC18738101Y00000X, 101YM0800X
TXLCDC9534101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty