Provider Demographics
NPI:1629350434
Name:COOPERATIVE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COOPERATIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-854-4651
Mailing Address - Street 1:1139 SPRUCE DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092
Mailing Address - Country:US
Mailing Address - Phone:908-731-7099
Mailing Address - Fax:908-731-7102
Practice Address - Street 1:1139 SPRUCE DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092
Practice Address - Country:US
Practice Address - Phone:908-731-7099
Practice Address - Fax:908-731-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0269484Medicaid