Healthcare Provider Details

I. General information

NPI: 1780482257
Provider Name (Legal Business Name): MASTERMIND COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALNUT AVE STE 210
CLARK NJ
07066-1269
US

IV. Provider business mailing address

100 WALNUT AVE STE 210
CLARK NJ
07066-1269
US

V. Phone/Fax

Practice location:
  • Phone: 908-514-8292
  • Fax:
Mailing address:
  • Phone: 908-514-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. ZOEY KYRIACOU
Title or Position: OWNER
Credential: LPC
Phone: 908-768-7039