Provider Demographics
NPI:1912250309
Name:JDK COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:JDK COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-944-0064
Mailing Address - Street 1:7833 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4231
Mailing Address - Country:US
Mailing Address - Phone:817-944-0064
Mailing Address - Fax:817-370-8977
Practice Address - Street 1:7833 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4231
Practice Address - Country:US
Practice Address - Phone:817-944-0064
Practice Address - Fax:817-370-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty