Provider Demographics
NPI:1578186128
Name:AGAPE COUNSELING SERVICES
Entity Type:Organization
Organization Name:AGAPE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLMHP
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-777-1451
Mailing Address - Street 1:PO BOX 31142
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-0142
Mailing Address - Country:US
Mailing Address - Phone:531-777-1451
Mailing Address - Fax:
Practice Address - Street 1:3223 N 45TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3711
Practice Address - Country:US
Practice Address - Phone:531-777-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty