Provider Demographics
NPI:1164951695
Name:ETERNAL GRATITUDE COUNSELING AND CONSULTATION
Entity Type:Organization
Organization Name:ETERNAL GRATITUDE COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-841-5164
Mailing Address - Street 1:9 STEEPLE CT
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1533
Mailing Address - Country:US
Mailing Address - Phone:609-841-5164
Mailing Address - Fax:
Practice Address - Street 1:9 STEEPLE COURT
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:609-841-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05344100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty