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General NPI Number Information
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NPI Number | 1003770413
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Entity Type | Organization
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Legal Business Name | COSMIC MIRROR COUNSELING LLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 144 PROSPECT ST
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City | BEREA
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State | OH
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Zip | 44017-2522
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Country | US
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Telephone | 330-853-9791
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Fax |
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Provider Business Mailing Address
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Address Line | 144 PROSPECT ST
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City | BEREA
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State | OH
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Zip | 44017-2522
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Country | US
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Telephone | 330-853-9791
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Fax |
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | JAMIE L BILLIE
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Credential | LPCC-S
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Telephone | 440-655-4726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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