Explore the Challenge

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37PC00088900 Issued in NJ

Legal business name

EXPLORE THE CHALLENGE

Practice address

30 Tecumseh TRL
Browns Mills, NJ 08015-6108

Phone

(609) 893-5600

Fax

(609) 893-3082

NPI assigned

May 21, 2007

Organization subpart

No

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

Authorized official

Name

William R. Fatum

Title

President

Phone

(609) 893-5600

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1700094638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207",
            "city": "NEW LISBON",
            "state": "NJ",
            "postal_code": "080640207",
            "telephone_number": "609-893-5600",
            "fax_number": "609-893-3082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 TECUMSEH TRL",
            "city": "BROWNS MILLS",
            "state": "NJ",
            "postal_code": "080156108",
            "telephone_number": "609-893-5600",
            "fax_number": "609-893-3082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPLORE THE CHALLENGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "FATUM",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-893-5600"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37PC00088900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Browns Mills, NJ
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• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.