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General NPI Number Information
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NPI Number | 1639634629
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Entity Type | Organization
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Legal Business Name | MIND OVER MATTER COUNSELING
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 92 NORTHWOODS BLVD STE C1
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City | COLUMBUS
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State | OH
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Zip | 43235-4720
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Country | US
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Telephone | 614-808-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 3153 DEVONSHIRE DR
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City | DELAWARE
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State | OH
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Zip | 43015-8420
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Country | US
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Telephone | 312-388-5101
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | KEELI LAURAN COOK
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Credential | LPCC
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Telephone | 312-388-5101
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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 |
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License Number State |
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