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General NPI Number Information
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NPI Number | 1568964872
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL MIND FAMILY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 15056 COLBERT ST. 03
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City | ROMULUS
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State | MI
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Zip | 48174-4817
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Country | US
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Telephone | 313-401-2655
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Fax |
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Provider Business Mailing Address
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Address Line | 15056 COLBERT ST. 03
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City | ROMULUS
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State | MI
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Zip | 48174-4817
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Country | US
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Telephone | 313-401-2655
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. LACARA S GILMORE
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Credential | MA
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Telephone | 734-404-8729
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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 | 4101006791
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License Number State | MI
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Taxonomy #2
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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 | MI
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