MEDICARE: COMPREHENSIVE COUNSELING SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1548797756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE COUNSELING SERVICE

Provider Business Mailing Address
First Line	:	4 SUBURBIA TER
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SUBURBIA TER
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1254
Country	:	US
Telephone Number	:	201-892-9349
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. LEONARD SMITH
Credential	:
Telephone Number	:	201-892-9349

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	05/18/2017

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