Healthcare Provider Details

I. General information

NPI: 1669604773
Provider Name (Legal Business Name): COUNSELING SERVICES GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N BACTON HILL RD SUITE 204
MALVERN PA
19355-1047
US

IV. Provider business mailing address

1 N BACTON HILL RD SUITE 204
MALVERN PA
19355-1047
US

V. Phone/Fax

Practice location:
  • Phone: 484-744-1005
  • Fax: 484-924-9934
Mailing address:
  • Phone: 484-744-1005
  • Fax: 484-924-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberPC000481
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC 000481
License Number StatePA

VIII. Authorized Official

Name: MS. CAROL A PUSEY
Title or Position: THERAPIST
Credential: M.A.,L.P.C.,C.A.C
Phone: 484-744-1005