=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710836739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAL AND RESET THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 W 7TH ST STE 100
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16502-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-603-3202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 N 50TH ST APT 2
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19139-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-603-3202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AJABEYANG AMIN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 267-603-3202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------