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General NPI Number Information
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NPI Number | 1689096927
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Entity Type | Organization
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Legal Business Name | MINDFUL MATTERS COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 17937 HALL RD
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City | MACOMB
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State | MI
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Zip | 48044-4557
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Country | US
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Telephone | 586-649-8410
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Fax | 586-569-2544
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Provider Business Mailing Address
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Address Line | 9443 NOOK RD
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City | CLAY
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State | MI
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Zip | 48001-4428
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Country | US
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Telephone | 586-649-8410
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Fax | 586-569-2544
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | DIANE SCHALK
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Credential | MA, LPC
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Telephone | 586-649-8410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401011374
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License Number State | MI
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