Provider Demographics
NPI:1902346927
Name:PROFESSIONAL MENTAL HEALTH & COUNSELING CORP PC
Entity type:Organization
Organization Name:PROFESSIONAL MENTAL HEALTH & COUNSELING CORP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:TORRES MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW, NSL
Authorized Official - Phone:787-325-6737
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-0414
Mailing Address - Country:US
Mailing Address - Phone:787-667-2437
Mailing Address - Fax:787-263-2512
Practice Address - Street 1:322 C DEL RECINTO SUR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-0000
Practice Address - Country:US
Practice Address - Phone:787-325-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
PR86861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN NUMBER