Organization Active NPI

Pastoral Counseling Center of Flushing

  • Pastoral Counselor
  • Flushing, NY
National Provider Identifier
1053535195
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pastoral CounselorTaxonomy code 101YP1600X
Legal business name
PASTORAL COUNSELING CENTER OF FLUSHING
Practice address
14210 Sanford Ave
Flushing, NY 11355-2577
Phone
(718) 463-4613
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Derith Ellen Van Etten, LMHCNPI 1922122472
Title
Founder Director
Phone
(718) 463-4613

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Pastoral CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP1600X Primary

Addresses

Primary practice location

14210 Sanford Ave
Flushing, NY 11355-2577

Mailing address

14210 Sanford Ave
Flushing, NY 11355-2577
Phone (718) 463-4613

National Provider Directory

National Provider Directory

Locations

14210 Sanford Ave
Flushing, NY 11355
Phone (718) 463-4613

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1053535195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14210 SANFORD AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552577",
            "telephone_number": "718-463-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14210 SANFORD AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552577",
            "telephone_number": "718-463-4613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASTORAL COUNSELING CENTER OF FLUSHING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "VAN ETTEN",
        "authorized_official_first_name": "DERITH",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "FOUNDER DIRECTOR",
        "authorized_official_telephone_number": "718-463-4613",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.