Healthcare Provider Details

I. General information

NPI: 1528736030
Provider Name (Legal Business Name): MY COUNSELING CANVAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 PARK AVE UNIT 404
SCOTCH PLAINS NJ
07076-6820
US

IV. Provider business mailing address

PO BOX 404
SCOTCH PLAINS NJ
07076-0404
US

V. Phone/Fax

Practice location:
  • Phone: 862-250-5303
  • Fax:
Mailing address:
  • Phone: 862-250-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PAIGE KING
Title or Position: OWNER
Credential:
Phone: 862-250-5303