Provider Demographics
NPI:1609129196
Name:PRECIOUS JEM COUNSELING AND YOUTH SERVICES
Entity type:Organization
Organization Name:PRECIOUS JEM COUNSELING AND YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:478-233-0415
Mailing Address - Street 1:107 CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-7253
Mailing Address - Country:US
Mailing Address - Phone:478-233-0415
Mailing Address - Fax:
Practice Address - Street 1:107 CHASE CIR
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-7253
Practice Address - Country:US
Practice Address - Phone:478-233-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health