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General NPI Number Information
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NPI Number | 1346649803
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Entity Type | Organization
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Legal Business Name | 'YOUR BEAUTIFUL MIND' COUNSELING SERVICE LLC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 6201 MILLER RD STE B
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-1598
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Country | US
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Telephone | 810-630-6784
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Fax | 810-644-7138
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Provider Business Mailing Address
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Address Line | 6201 MILLER RD STE B
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-1598
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Country | US
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Telephone | 810-630-6784
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Fax | 810-644-7138
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. CHERYL LEONE GASPAR
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Credential | MA LMSW LPC
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Telephone | 810-630-6784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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