Provider Demographics
NPI:1477027696
Name:COFFEE CLUTCH COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COFFEE CLUTCH COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-408-9379
Mailing Address - Street 1:2151 LAFAYETTE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-2910
Mailing Address - Country:US
Mailing Address - Phone:315-408-9379
Mailing Address - Fax:561-282-3238
Practice Address - Street 1:2151 LAFAYETTE AVE STE 105
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805-2910
Practice Address - Country:US
Practice Address - Phone:315-408-9379
Practice Address - Fax:561-282-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty