Provider Demographics
NPI:1093535395
Name:THE PASTORS LOUNGE LLC
Entity type:Organization
Organization Name:THE PASTORS LOUNGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER AND CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:JENICE
Authorized Official - Last Name:TENNANT-STRAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-844-1080
Mailing Address - Street 1:192 BENNETTS LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5051
Mailing Address - Country:US
Mailing Address - Phone:908-844-1080
Mailing Address - Fax:
Practice Address - Street 1:11 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3630
Practice Address - Country:US
Practice Address - Phone:908-844-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty