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General NPI Number Information
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NPI Number | 1306070032
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Entity Type | Organization
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Legal Business Name | ALONG THE PATH COUNSELING SERVICES P.C.
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Dates
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Enumeration Date | 05/09/2009
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Last Update Date | 05/09/2009
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Provider Practice Location Address
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Address Line | 433 S PHELPS AVE SUITE 2
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City | ROCKFORD
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State | IL
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Zip | 61108-2442
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Country | US
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Telephone | 815-397-4287
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Fax | 815-397-3136
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Provider Business Mailing Address
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Address Line | 433 S PHELPS AVE SUITE 2
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City | ROCKFORD
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State | IL
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Zip | 61108-2442
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Country | US
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Telephone | 815-397-4287
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Fax | 815-397-3136
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON ANDREW PECKELS
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Credential | LCPC
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Telephone | 414-801-7905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 060010196
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License Number State | IL
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