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General NPI Number Information
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NPI Number | 1881052397
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Entity Type | Organization
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Legal Business Name | MINDFUL MATTERS CHILD & ADOLESCENT COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 111 E MIDLAND RD
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City | AUBURN
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State | MI
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Zip | 48611-9780
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Country | US
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Telephone | 989-266-3421
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E MIDLAND RD
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City | AUBURN
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State | MI
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Zip | 48611-9780
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Country | US
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Telephone | 989-266-3421
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | HEATHER NOTTER
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Credential | LPC
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Telephone | 989-266-3421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 6401007631
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License Number State | MI
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