Provider Demographics
NPI:1437805579
Name:BIG UMBRELLA COUNSELING
Entity Type:Organization
Organization Name:BIG UMBRELLA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-278-1239
Mailing Address - Street 1:PO BOX 1884
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-1884
Mailing Address - Country:US
Mailing Address - Phone:912-590-2981
Mailing Address - Fax:
Practice Address - Street 1:6959 HACKLEBARNEY RD
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-4692
Practice Address - Country:US
Practice Address - Phone:912-278-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1093299356Medicaid
GA1063996619Medicaid