Provider Demographics
NPI:1720322761
Name:COURAGEOUS LIVING COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COURAGEOUS LIVING COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER AND PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIANNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:215-859-1252
Mailing Address - Street 1:22 N PRICE ST STE A
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4912
Mailing Address - Country:US
Mailing Address - Phone:215-859-1252
Mailing Address - Fax:
Practice Address - Street 1:22 N PRICE ST STE A
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4912
Practice Address - Country:US
Practice Address - Phone:215-859-1252
Practice Address - Fax:215-701-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006492101YP2500X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty