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General NPI Number Information
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NPI Number | 1538420716
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Entity Type | Organization
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Legal Business Name | BEDROCK COUNSELING MINISTRIES
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 8130 OSWEGO RD SUITE 1
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City | LIVERPOOL
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State | NY
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Zip | 13090-1520
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Country | US
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Telephone | 315-652-0000
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Fax | 315-652-2736
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Provider Business Mailing Address
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Address Line | 8130 OSWEGO RD SUITE 1
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City | LIVERPOOL
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State | NY
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Zip | 13090-1520
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Country | US
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Telephone | 315-652-0000
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Fax | 315-652-2736
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN D. DURST
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Credential | L.M.H.C., N.C.C.
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Telephone | 315-652-0000
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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 | 004235
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License Number State |
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