=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346018595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGN MIND THERAPY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2023
-----------------------------------------------------
Last Update Date | 12/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 WEST 7TH STREET SUITE 100
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-417-6023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 W 7TH ST STE 100
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16502-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/PSYCHOTHERAPIST
-----------------------------------------------------
Name | NIPA DESAI
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 267-417-6083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------