=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215207766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONSULTANTS OF MIND MATTERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2011
-----------------------------------------------------
Last Update Date | 12/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 VICTORY PARKWAY SUITE 602
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-244-6990
-----------------------------------------------------
Fax | 513-244-6911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 364 GRAND AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-244-6990
-----------------------------------------------------
Fax | 513-244-6911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CAROLE STOKES-BREWER
-----------------------------------------------------
Credential | PHD, LISW-S, LPCC
-----------------------------------------------------
Telephone | 513-244-6990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E1247
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I3014
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------