Provider Demographics
NPI:1235676461
Name:PERFORMANCE COUNSELING LLC
Entity Type:Organization
Organization Name:PERFORMANCE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:856-208-4141
Mailing Address - Street 1:860 ROUTE 168
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3215
Mailing Address - Country:US
Mailing Address - Phone:856-208-4141
Mailing Address - Fax:856-401-9551
Practice Address - Street 1:860 ROUTE 168
Practice Address - Street 2:SUITE 104
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3215
Practice Address - Country:US
Practice Address - Phone:856-208-4141
Practice Address - Fax:856-401-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00021600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health