Healthcare Provider Details

I. General information

NPI: 1477605707
Provider Name (Legal Business Name): PASTORAL INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 15TH AVE
COLUMBUS GA
31901-1608
US

IV. Provider business mailing address

2022 15TH AVE
COLUMBUS GA
31901-1608
US

V. Phone/Fax

Practice location:
  • Phone: 706-649-6500
  • Fax: 706-649-6521
Mailing address:
  • Phone: 706-649-6500
  • Fax: 706-649-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SANDY HARRIS
Title or Position: CFO
Credential:
Phone: 706-649-6500