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General NPI Number Information
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NPI Number | 1710904461
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Entity Type | Organization
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Legal Business Name | PEMBERTON COUNSELING SERVICES, PSC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1700 UPS DR SUITE 107
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City | LOUISVILLE
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State | KY
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Zip | 40223-4046
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Country | US
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Telephone | 502-327-8045
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Fax | 502-327-7227
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Provider Business Mailing Address
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Address Line | 1700 UPS DR SUITE 107
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City | LOUISVILLE
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State | KY
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Zip | 40223-4046
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Country | US
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Telephone | 502-327-8045
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Fax | 502-327-7227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES PEMBERTON JR.
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Credential |
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Telephone | 502-327-8045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | KY-0549
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License Number State | KY
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