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General NPI Number Information
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NPI Number | 1740654417
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Entity Type | Organization
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Legal Business Name | INSIGHTFUL MIND COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 36 MIDVALE RD LOWER LEVEL 5
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1353
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Country | US
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Telephone | 973-750-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 36 MIDVALE RD LOWER LEVEL 5
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1353
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Country | US
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Telephone | 973-750-4111
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICIAN
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Name | MR. ROY STEPHAN CORSON
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Credential | M.ED., L.P.C., N.C.C
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Telephone | 973-750-4111
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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 | 37PC00511900
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License Number State | NJ
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