Healthcare Provider Details

I. General information

NPI: 1407103641
Provider Name (Legal Business Name): MIRACLES OF THE MIND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 CHURCH RD SUITE 137
CHERRY HILL NJ
08002-1412
US

IV. Provider business mailing address

811 CHURCH RD SUITE 137
CHERRY HILL NJ
08002-1412
US

V. Phone/Fax

Practice location:
  • Phone: 856-904-3525
  • Fax:
Mailing address:
  • Phone: 856-904-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: VALERIE TRAVIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 856-904-3525