Provider Demographics
NPI:1962117671
Name:HOPE HARBOR COUNSELING CENTER LLC
Entity type:Organization
Organization Name:HOPE HARBOR COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:FAMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-631-7561
Mailing Address - Street 1:108 W COLUMBIA ST STE B
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1719
Mailing Address - Country:US
Mailing Address - Phone:573-631-9091
Mailing Address - Fax:
Practice Address - Street 1:108 W COLUMBIA ST STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1719
Practice Address - Country:US
Practice Address - Phone:573-631-9091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty