1669604773 NPI number — COUNSELING SERVICES GROUP

Table of content: (NPI 1669604773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669604773 NPI number — COUNSELING SERVICES GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING SERVICES GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669604773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 N BACTON HILL RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-744-1005
Provider Business Mailing Address Fax Number:
484-924-9934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 N BACTON HILL RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MALVERN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19355-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-744-1005
Provider Business Practice Location Address Fax Number:
484-924-9934
Provider Enumeration Date:
08/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PUSEY
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
484-744-1005

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PC 000481 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: PC000481 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC000481 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: ICADC 25103 . This is a "INTERNATIONALLY CERTIFIED ALCOHOL & DRUG COUNSELOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2518 . This is a "CERTIFIED ADDICTIONS COUNSELOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6491 . This is a "CERTIFIED CO-OCCURRING DISORDERS PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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