Basic Information
| Provider Information | |||||||||
| NPI: | 1003003930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEHAN | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MA, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 FITZWATERTOWN RD | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156584550 | ||||||||
| FaxNumber: | 2156584551 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 FITZWATERTOWN RD | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156584550 | ||||||||
| FaxNumber: | 2156584551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 101YP2500X | PC008035 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | PC008035 | 01 | PA | STATE LICENSE | OTHER |