Provider Demographics
NPI:1417080003
Name:COOPERATIVE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:COOPERATIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:KIRSTEN
Authorized Official - Last Name:MOORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-577-0818
Mailing Address - Street 1:1139 SPRUCE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2221
Mailing Address - Country:US
Mailing Address - Phone:908-731-7099
Mailing Address - Fax:908-731-7102
Practice Address - Street 1:1139 SPRUCE DR STE 2
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2221
Practice Address - Country:US
Practice Address - Phone:908-731-7099
Practice Address - Fax:908-731-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO4843600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0087751Medicaid