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General NPI Number Information
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NPI Number | 1588047542
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Entity Type | Organization
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Legal Business Name | NEW STATE OF MIND LLC
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 2836 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2902
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Country | US
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Telephone | 734-250-4544
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Fax | 734-818-1445
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Provider Business Mailing Address
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Address Line | 2836 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2902
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Country | US
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Telephone | 734-250-4544
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Fax | 734-818-1445
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Authorized Official
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Title or Position | OWNER
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Name | MS. KATE LAFAYETTE
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Credential | M.S.S.A., LMSW
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Telephone | 734-250-4544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801066229
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License Number State | MI
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