Provider Demographics
NPI:1528342847
Name:PSE COUNSELING & CONSULTING SERVICES LLC
Entity type:Organization
Organization Name:PSE COUNSELING & CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:V
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-658-0384
Mailing Address - Street 1:225 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-5108
Mailing Address - Country:US
Mailing Address - Phone:678-658-0384
Mailing Address - Fax:
Practice Address - Street 1:225 CEDAR RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-5108
Practice Address - Country:US
Practice Address - Phone:678-658-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004700251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA453693822AMedicaid