=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285240549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PJMJ COUNSELLING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2020
-----------------------------------------------------
Last Update Date | 09/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 ALGER AVE
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-4313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-225-8936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 ALGER AVE
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-4313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PETER MURPHY
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 401-225-8936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------