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NPI Code Detail

MEDICARE: MIND AND HEART COUNSELING, PLC

MEDICARE: MIND AND HEART COUNSELING, PLC
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1073233128
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND AND HEART COUNSELING, PLC
Provider Business Mailing Address
First Line : PO BOX 322
Second Line :
City : MIDDLEBURY
State : VT
Zip : 05753-0322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1028 LAKE DUNMORE RD
Second Line :
City : SALISBURY
State : VT
Zip : 05769-9755
Country : US
Telephone Number : 802-735-9080
Fax Number :
Authorized Official
Title or Position : LCMHC
Name : GAVIN FLANAGAN
Credential :
Telephone Number : 802-735-9080
Provider Enumeration Date : 08/30/2022
Last Update Date : 08/30/2022

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Directions to “MIND AND HEART COUNSELING, PLC ” Practice Location

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