Provider Demographics
NPI:1689777641
Name:CKL COUNSELING, RLLP
Entity Type:Organization
Organization Name:CKL COUNSELING, RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMBOUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-296-1742
Mailing Address - Street 1:396 ROUTES 6 AND 209
Mailing Address - Street 2:STE 3B
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337
Mailing Address - Country:US
Mailing Address - Phone:570-296-1742
Mailing Address - Fax:
Practice Address - Street 1:396 ROUTE 6 AND 209 STE 3B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9490
Practice Address - Country:US
Practice Address - Phone:570-296-1742
Practice Address - Fax:570-296-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006796L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACK026676Medicare ID - Type UnspecifiedMENTAL HEALTH COUNSELING