Provider Demographics
NPI:1285160101
Name:HOLCOMB BEHAVIORAL HEALTH SYSTEMS
Entity type:Organization
Organization Name:HOLCOMB BEHAVIORAL HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBIL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYLL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSC
Authorized Official - Phone:484-824-9870
Mailing Address - Street 1:773 MOUNT LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1562
Mailing Address - Country:US
Mailing Address - Phone:484-824-9870
Mailing Address - Fax:
Practice Address - Street 1:1011 REED AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2002
Practice Address - Country:US
Practice Address - Phone:610-939-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health