1245955111 NPI number — AGAPE COUNSELING, LLC

Table of content: (NPI 1245955111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245955111 NPI number — AGAPE COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE COUNSELING, LLC
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:
1245955111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 ALMOND TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88101-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-497-2265
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 ALMOND TREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88101-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-497-2265
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
SETH
Authorized Official Middle Name:
SEBASTIAN
Authorized Official Title or Position:
LCSW
Authorized Official Telephone Number:
850-497-2265

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1568012870 . This is a "TYPE 1 NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 21006768 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com