1689329468 NPI number — AMETHYST GROWTH & COUNSELING SERVICES

Table of content: (NPI 1689329468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689329468 NPI number — AMETHYST GROWTH & COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMETHYST GROWTH & COUNSELING SERVICES
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:
AMETHYST PERSONAL GROWTH & COUNSELING SERVICES, LLC
Provider Other Organization Name Type Code:
5
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:
1689329468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 S 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08037-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-704-5384
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMONTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08037-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-704-5384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HARSHE
Authorized Official First Name:
PRAJAKTA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-704-5383

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0807X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1689329468 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1659520559 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1790879088 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1932123122 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1174033252 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1770032237 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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