MEDICARE: THE COUNSELING CLUIB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1568219442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COUNSELING CLUIB LLC

Provider Business Mailing Address
First Line	:	408 PINES LAKE DR E
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5062
Country	:	US
Telephone Number	:	201-280-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 PINES LAKE DR E
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5062
Country	:	US
Telephone Number	:	201-280-4878
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN COSGROVE
Credential	:	LPC
Telephone Number	:	201-280-4878

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/30/2024

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Directions to “THE COUNSELING CLUIB LLC ” Practice Location

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