Provider Demographics
NPI:1477152171
Name:JLG COUNSELING SERVICES
Entity Type:Organization
Organization Name:JLG COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-512-1456
Mailing Address - Street 1:584 BELMAWR PLACE
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108
Mailing Address - Country:US
Mailing Address - Phone:301-512-1456
Mailing Address - Fax:
Practice Address - Street 1:584 BELMAWR PLACE
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108
Practice Address - Country:US
Practice Address - Phone:301-512-1456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health