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General NPI Number Information
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NPI Number | 1184371825
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Entity Type | Organization
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Legal Business Name | OPEN MIND COUNSELING LLC
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 95 ALLENS CREEK RD BLDG 2, STE 325
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City | ROCHESTER
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State | NY
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Zip | 14618
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Country | US
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Telephone | 585-999-5145
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Fax |
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Provider Business Mailing Address
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Address Line | 44 HARWOOD CIR
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City | ROCHESTER
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State | NY
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Zip | 14625-1610
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Country | US
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Telephone | 585-999-5145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELODY WOLLGREN
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Credential | LCSW
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Telephone | 585-999-5145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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