1740654417 NPI number — INSIGHTFUL MIND COUNSELING SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740654417 NPI number — INSIGHTFUL MIND COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHTFUL MIND COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740654417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 MIDVALE RD
Provider Second Line Business Mailing Address:
LOWER LEVEL 5
Provider Business Mailing Address City Name:
MOUNTAIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07046-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-750-4111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 MIDVALE RD
Provider Second Line Business Practice Location Address:
LOWER LEVEL 5
Provider Business Practice Location Address City Name:
MOUNTAIN LAKES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07046-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-750-4111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CORSON
Authorized Official First Name:
ROY
Authorized Official Middle Name:
STEPHAN
Authorized Official Title or Position:
OWNER/ CLINICIAN
Authorized Official Telephone Number:
973-750-4111

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  37PC00511900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com