Provider Demographics
NPI:1538420716
Name:BEDROCK COUNSELING MINISTRIES
Entity type:Organization
Organization Name:BEDROCK COUNSELING MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURST
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:315-652-0000
Mailing Address - Street 1:8130 OSWEGO RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1520
Mailing Address - Country:US
Mailing Address - Phone:315-652-0000
Mailing Address - Fax:315-652-2736
Practice Address - Street 1:8130 OSWEGO RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1520
Practice Address - Country:US
Practice Address - Phone:315-652-0000
Practice Address - Fax:315-652-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
004235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty