Healthcare Provider Details

I. General information

NPI: 1740831734
Provider Name (Legal Business Name): PATRICIA MUYSKENS COUNSELING AND CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W KIRKWOOD AVE STE 222
BLOOMINGTON IN
47404-6133
US

IV. Provider business mailing address

715 N PLYMOUTH RD
BLOOMINGTON IN
47408-3066
US

V. Phone/Fax

Practice location:
  • Phone: 812-219-1314
  • Fax:
Mailing address:
  • Phone: 812-219-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MUYSKENS
Title or Position: OWNER
Credential: LCSW
Phone: 812-219-1314