Provider Demographics
NPI:1336896331
Name:JERICHO FAMILY COUNSELING LLC
Entity Type:Organization
Organization Name:JERICHO FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSMFT, LPC
Authorized Official - Phone:334-267-5313
Mailing Address - Street 1:412 CENTENARY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY GRANDE
Mailing Address - State:AL
Mailing Address - Zip Code:36701-3528
Mailing Address - Country:US
Mailing Address - Phone:334-267-5313
Mailing Address - Fax:
Practice Address - Street 1:2193 BROAD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4142
Practice Address - Country:US
Practice Address - Phone:334-267-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty