Provider Demographics
NPI:1699217364
Name:COUNSELING AND PSYCHOLOGICAL SERVICES OF THE UPSTATE
Entity type:Organization
Organization Name:COUNSELING AND PSYCHOLOGICAL SERVICES OF THE UPSTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-633-0210
Mailing Address - Street 1:224 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2347
Mailing Address - Country:US
Mailing Address - Phone:864-633-0210
Mailing Address - Fax:864-722-5380
Practice Address - Street 1:224 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2347
Practice Address - Country:US
Practice Address - Phone:864-633-0210
Practice Address - Fax:864-722-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-13
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1323103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty