=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922601665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLOURISHING MIND COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2020
-----------------------------------------------------
Last Update Date | 11/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 EXCHANGE ST STE 203
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-566-6133
-----------------------------------------------------
Fax | 207-407-7223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 84 COLLEY BROOK DR
-----------------------------------------------------
City | WINDHAM
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04062-4557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-566-6133
-----------------------------------------------------
Fax | 207-407-7223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST/OWNER
-----------------------------------------------------
Name | KATHERINE J STEIN
-----------------------------------------------------
Credential | LCPC, LADC
-----------------------------------------------------
Telephone | 603-566-6133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------