Provider Demographics
NPI:1710904461
Name:PEMBERTON COUNSELING SERVICES, PSC
Entity Type:Organization
Organization Name:PEMBERTON COUNSELING SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:502-327-8045
Mailing Address - Street 1:1700 UPS DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4046
Mailing Address - Country:US
Mailing Address - Phone:502-327-8045
Mailing Address - Fax:502-327-7227
Practice Address - Street 1:1700 UPS DR
Practice Address - Street 2:SUITE 107
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4046
Practice Address - Country:US
Practice Address - Phone:502-327-8045
Practice Address - Fax:502-327-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty