Provider Demographics
NPI:1568567444
Name:COMPREHENSIVE COUNSELING SERVICES PC
Entity Type:Organization
Organization Name:COMPREHENSIVE COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-491-6143
Mailing Address - Street 1:1800 JOHN F KENNEDY BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7421
Mailing Address - Country:US
Mailing Address - Phone:267-977-0850
Mailing Address - Fax:215-491-6144
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7421
Practice Address - Country:US
Practice Address - Phone:267-977-0850
Practice Address - Fax:215-322-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005921L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA668005Medicare UPIN