1255509394 NPI number — LECHRIS COUNSELING SERVICES, INC.

Table of content: JON A. BRINKMAN D.O. (NPI 1497785737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255509394 NPI number — LECHRIS COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LECHRIS COUNSELING SERVICES, INC.
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:
6
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:
1255509394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 BRIDGES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28557-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-636-6105
Provider Business Mailing Address Fax Number:
252-636-6109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 BRIDGES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-636-6105
Provider Business Practice Location Address Fax Number:
252-636-6109
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARZ
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
252-636-6105

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-016-063 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8302207 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302207S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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