Healthcare Provider Details

I. General information

NPI: 1285243253
Provider Name (Legal Business Name): MIND CLEAR INTEGRATIVE PSYCHOLOGICAL PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 7TH AVE FL 12A
NEW YORK NY
10001-5893
US

IV. Provider business mailing address

PO BOX 1126
NEW YORK NY
10113-1126
US

V. Phone/Fax

Practice location:
  • Phone: 212-547-9853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NOEL HUNTER
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 212-547-9853