Healthcare Provider Details

I. General information

NPI: 1629350434
Provider Name (Legal Business Name): COOPERATIVE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 SPRUCE DRIVE SUITE 2
MOUNTAINSIDE NJ
07092
US

IV. Provider business mailing address

1139 SPRUCE DRIVE SUITE 2
MOUNTAINSIDE NJ
07092
US

V. Phone/Fax

Practice location:
  • Phone: 908-731-7099
  • Fax: 908-731-7102
Mailing address:
  • Phone: 908-731-7099
  • Fax: 908-731-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY JONES
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 908-854-4651