Healthcare Provider Details

I. General information

NPI: 1386094324
Provider Name (Legal Business Name): BEUTIFUL MIND COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
EAST STROUDSBURG PA
18301-2816
US

IV. Provider business mailing address

1 WASHINGTON ST
EAST STROUDSBURG PA
18301-2816
US

V. Phone/Fax

Practice location:
  • Phone: 570-426-7150
  • Fax: 570-426-9484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC002949
License Number StatePA

VIII. Authorized Official

Name: TERESA BARRY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 570-426-7150