1750893905 NPI number — PARHAM COUNSELING SERVICES, LLC

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 1750893905 NPI number — PARHAM COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARHAM COUNSELING SERVICES, 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:
1750893905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 ANDREA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360-1680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-235-9269
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 MAIN ST UNIT 3-A3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-5732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-235-9269
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PARHAM
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
860-235-9269

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  000866 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1003056458 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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