1669604773 NPI number — COUNSELING SERVICES GROUP

Table of Contents

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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