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General NPI Number Information
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NPI Number | 1619422615
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Entity Type | Organization
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Legal Business Name | MIND OVER MATTER PROFESSIONAL COUNSELING SERVICES
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 111 S SPRING ST
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City | BELLEFONTE
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State | PA
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Zip | 16823-1335
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Country | US
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Telephone | 814-571-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 138 ARCHERS GLEN RD
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City | BELLEFONTE
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State | PA
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Zip | 16823-6457
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Country | US
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Telephone | 814-571-6620
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Fax | 814-470-8744
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | AMBER KRESOVICH
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Credential | LPC
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Telephone | 814-571-6620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC007780
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License Number State | PA
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