Healthcare Provider Details

I. General information

NPI: 1245955111
Provider Name (Legal Business Name): AGAPE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 ALMOND TREE LN
CLOVIS NM
88101-1742
US

IV. Provider business mailing address

308 ALMOND TREE LN
CLOVIS NM
88101-1742
US

V. Phone/Fax

Practice location:
  • Phone: 850-497-2265
  • Fax:
Mailing address:
  • Phone: 850-497-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH SEBASTIAN BAKER
Title or Position: LCSW
Credential: LCSW
Phone: 850-497-2265