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General NPI Number Information
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NPI Number | 1215742275
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Entity Type | Organization
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Legal Business Name | J.B. FAMILY COUNSELING CENTER LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 9321 WICKER AVE STE 205
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City | SAINT JOHN
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State | IN
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Zip | 46373-2301
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Country | US
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Telephone | 219-558-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 9321 WICKER AVE STE 205
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City | SAINT JOHN
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State | IN
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Zip | 46373-2301
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Country | US
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Telephone | 219-558-0232
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JOSEPH MICHAEL AGUILERA
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Credential |
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Telephone | 219-558-0232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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