1801919469 NPI number — ODYSSEY COUNSELING, LLC

Table of content: (NPI 1801919469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801919469 NPI number — ODYSSEY COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODYSSEY 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:
1801919469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 MARLTON PIKE E
Provider Second Line Business Mailing Address:
SUITE N70
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-985-6300
Provider Business Mailing Address Fax Number:
856-985-6424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 MARLTON PIKE E
Provider Second Line Business Practice Location Address:
SUITE N70
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-985-6300
Provider Business Practice Location Address Fax Number:
856-985-6424
Provider Enumeration Date:
04/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRESLOW
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
856-985-6300

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04407500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 364SP0809X , with the licence number: 26NC09079300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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