MEDICARE: MINDFUL LIVING THERAPY BY MARCELA COUNSELING AND WELLNESS CENTER 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	:	1861156358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL LIVING THERAPY BY MARCELA COUNSELING AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	6411 GRAND AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3525
Country	:	US
Telephone Number	:	954-899-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 ANDERSON AVE
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1401
Country	:	US
Telephone Number	:	201-920-7566
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARCELA FARFAN
Credential	:	LPC
Telephone Number	:	201-920-7566

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	02/05/2024

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