Healthcare Provider Details

I. General information

NPI: 1215085311
Provider Name (Legal Business Name): PASTORAL COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 MANGO PL
JACKSONVILLE FL
32207-3326
US

IV. Provider business mailing address

2140 MANGO PL
JACKSONVILLE FL
32207-3326
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-2437
  • Fax: 904-346-3064
Mailing address:
  • Phone: 904-398-2437
  • Fax: 904-346-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT1294
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberIMH14246
License Number StateFL

VIII. Authorized Official

Name: MR. CLIFTON EARL THOMAS
Title or Position: DEVELOPMENT DIRECTOR
Credential:
Phone: 904-398-2437