Provider Demographics
NPI:1528563475
Name:QUISPE COUNSELING AND THERAPY LLC
Entity Type:Organization
Organization Name:QUISPE COUNSELING AND THERAPY LLC
Other - Org Name:COURAGEOUS THERAPY NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:QUISPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-941-9640
Mailing Address - Street 1:350 W PASSAIC ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3000
Mailing Address - Country:US
Mailing Address - Phone:973-941-9640
Mailing Address - Fax:855-325-9859
Practice Address - Street 1:350 W PASSAIC ST STE 4
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3000
Practice Address - Country:US
Practice Address - Phone:973-282-6299
Practice Address - Fax:855-325-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00578300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty