Healthcare Provider Details

I. General information

NPI: 1093619413
Provider Name (Legal Business Name): PROHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAIN ST STE 306
BELLEVILLE NJ
07109-3013
US

IV. Provider business mailing address

135 MAIN ST STE 306
BELLEVILLE NJ
07109-3013
US

V. Phone/Fax

Practice location:
  • Phone: 862-588-9363
  • Fax:
Mailing address:
  • Phone: 862-588-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EBONY MCGILL
Title or Position: CFO
Credential: CPC
Phone: 862-588-9363