Healthcare Provider Details

I. General information

NPI: 1770133407
Provider Name (Legal Business Name): A FRAME OF MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 09/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 E APPLE AVE
MUSKEGON MI
49442-4502
US

IV. Provider business mailing address

1204 4TH ST
MUSKEGON MI
49441-2006
US

V. Phone/Fax

Practice location:
  • Phone: 231-340-2263
  • Fax:
Mailing address:
  • Phone: 231-286-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINA COOPER
Title or Position: OWNER
Credential: LMSW
Phone: 231-340-2263