Provider Demographics
NPI:1255068532
Name:JEREMIAH COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:JEREMIAH COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRETTA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-239-2893
Mailing Address - Street 1:519 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0760
Mailing Address - Country:US
Mailing Address - Phone:612-239-2893
Mailing Address - Fax:
Practice Address - Street 1:519 MONTROSE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-0760
Practice Address - Country:US
Practice Address - Phone:612-239-2893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty