Provider Demographics
NPI:1700540903
Name:YAQUB COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:YAQUB COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:NUMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAQUB
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-296-4410
Mailing Address - Street 1:701 W BROAD ST STE 217
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5229
Mailing Address - Country:US
Mailing Address - Phone:239-296-4410
Mailing Address - Fax:
Practice Address - Street 1:701 W BROAD ST STE 217
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5229
Practice Address - Country:US
Practice Address - Phone:239-296-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty