1750909644 NPI number — MIND MEETS MOVEMENT COUNSELING SERVICES, PLLC

Table of content: (NPI 1750909644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750909644 NPI number — MIND MEETS MOVEMENT COUNSELING SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIND MEETS MOVEMENT COUNSELING SERVICES, PLLC
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:
KATIUSCIA GRAY, LCSW
Provider Other Organization Name Type Code:
3
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:
1750909644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERNE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11565-0072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-415-4562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
381 SUNRISE HWY STE 602
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11563-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-500-3528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
KATIUSCIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER/ EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
516-500-3528

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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