Provider Demographics
NPI:1306934757
Name:PASTORAL COUNSELING SERVICES-UNITED CHURCH OF CHRIST, INC.
Entity type:Organization
Organization Name:PASTORAL COUNSELING SERVICES-UNITED CHURCH OF CHRIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:603-627-2702
Mailing Address - Street 1:2013 ELM ST
Mailing Address - Street 2:MANNING HOUSE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2528
Mailing Address - Country:US
Mailing Address - Phone:603-627-2702
Mailing Address - Fax:603-627-3543
Practice Address - Street 1:2013 ELM ST
Practice Address - Street 2:MANNING HOUSE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2528
Practice Address - Country:US
Practice Address - Phone:603-627-2702
Practice Address - Fax:603-627-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075562Medicaid
NHRE4416Medicare PIN