Provider Demographics
NPI:1245690437
Name:JAY PESEK COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:JAY PESEK COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:T
Authorized Official - Last Name:PESEK
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-624-3076
Mailing Address - Street 1:277 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-4028
Mailing Address - Country:US
Mailing Address - Phone:205-624-3076
Mailing Address - Fax:844-835-1972
Practice Address - Street 1:277 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-4028
Practice Address - Country:US
Practice Address - Phone:205-624-3076
Practice Address - Fax:844-835-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3568101Y00000X
AL2316101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL182873Medicaid