MEDICARE: MIND THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000	OTHER		N/A

General Provider Information

NPI Number	:	1013519818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND THERAPY

Provider Business Mailing Address
First Line	:	150 50TH AVE APT 612
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-6064
Country	:	US
Telephone Number	:	718-685-8430
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 50TH AVE APT 612
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-6064
Country	:	US
Telephone Number	:	718-685-8430
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	ALLA NEKTALOV
Credential	:
Telephone Number	:	718-685-8430

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “MIND THERAPY ” Practice Location

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