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NPI Code Detail

MEDICARE: CRJ COUNSELING, LLC

MEDICARE: CRJ COUNSELING, LLC
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
1251S00000XCommunity/Behavioral Health AgencyLAC1019KS
2251S00000XCommunity/Behavioral Health AgencyLCPC2407KS

General Provider Information

NPI Number : 1902292469
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRJ COUNSELING, LLC
Provider Business Mailing Address
First Line : 2006 1ST AVE
Second Line :
City : DODGE CITY
State : KS
Zip : 67801-2623
Country : US
Telephone Number : 620-371-6548
Fax Number : 620-371-7119
Provider Business Practice Location Address
First Line : 2006 1ST AVE
Second Line :
City : DODGE CITY
State : KS
Zip : 67801-2623
Country : US
Telephone Number : 620-371-6548
Fax Number : 620-371-7119
Authorized Official
Title or Position : OWNER/THERAPIST
Name : CINDY RENEE JACOBS
Credential : LCPC
Telephone Number : 620-371-6548
Provider Enumeration Date : 04/11/2015
Last Update Date : 04/11/2015

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Directions to “CRJ COUNSELING, LLC ” Practice Location

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