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General NPI Number Information
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NPI Number | 1215085311
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Entity Type | Organization
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Legal Business Name | PASTORAL COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 2140 MANGO PL
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3326
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Country | US
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Telephone | 904-398-2437
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Fax | 904-346-3064
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Provider Business Mailing Address
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Address Line | 2140 MANGO PL
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3326
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Country | US
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Telephone | 904-398-2437
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Fax | 904-346-3064
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Authorized Official
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Title or Position | DEVELOPMENT DIRECTOR
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Name | MR. CLIFTON EARL THOMAS
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Credential |
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Telephone | 904-398-2437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT1294
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | IMH14246
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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