Healthcare Provider Details

I. General information

NPI: 1790448413
Provider Name (Legal Business Name): JASON WALKER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S BROADWAY # 7
PITMAN NJ
08071-2235
US

IV. Provider business mailing address

140 S BROADWAY # 7
PITMAN NJ
08071-2235
US

V. Phone/Fax

Practice location:
  • Phone: 856-404-0251
  • Fax:
Mailing address:
  • Phone: 856-404-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON WALKER
Title or Position: LPC
Credential:
Phone: 856-404-0251