Healthcare Provider Details

I. General information

NPI: 1235676461
Provider Name (Legal Business Name): PERFORMANCE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ROUTE 168 SUITE 104
TURNERSVILLE NJ
08012-3215
US

IV. Provider business mailing address

860 ROUTE 168 SUITE 104
TURNERSVILLE NJ
08012-3215
US

V. Phone/Fax

Practice location:
  • Phone: 856-208-4141
  • Fax: 856-401-9551
Mailing address:
  • Phone: 856-208-4141
  • Fax: 856-401-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37PC00021600
License Number StateNJ

VIII. Authorized Official

Name: DONALD P KELLER
Title or Position: THERAPIST
Credential: LPC, LCADC
Phone: 856-208-4141