MEDICARE: SKYHEART COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013533074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYHEART COUNSELING LLC

Provider Business Mailing Address
First Line	:	634 EAGLE ROCK AVE UNIT 202
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-6801
Country	:	US
Telephone Number	:	386-316-9713
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MARION DR
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-3301
Country	:	US
Telephone Number	:	973-486-4559
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD MOHAMMED
Credential	:	MA, LPC, NCC
Telephone Number	:	973-486-4559

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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Directions to “SKYHEART COUNSELING LLC ” Practice Location

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