=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447961800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAZARETH COUNSELING COMPANY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2022
-----------------------------------------------------
Last Update Date | 12/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 547 W 147TH ST SUITE F2
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10031-4445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-719-1229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 W 147TH ST SUITE F2
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10031-4445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-719-1229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | BARRY J WINLEY
-----------------------------------------------------
Credential | MA, NCC, LMHC
-----------------------------------------------------
Telephone | 646-719-1229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------