Healthcare Provider Details

I. General information

NPI: 1124955331
Provider Name (Legal Business Name): THERAPY MINDSET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TULIP DR APT 3C
FORDS NJ
08863-1138
US

IV. Provider business mailing address

6 TULIP DR APT 3C
FORDS NJ
08863-1138
US

V. Phone/Fax

Practice location:
  • Phone: 973-259-6673
  • Fax:
Mailing address:
  • Phone: 973-259-6673
  • 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: MRS. MALIKA BOLA
Title or Position: OWNER
Credential: LPC, CCS, ACS
Phone: 973-259-6673