MEDICARE: HEART AND MIND COUNSELING, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1215508627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART AND MIND COUNSELING, LLC

Provider Business Mailing Address
First Line	:	135 N OLD WOODWARD AVE STE 200
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-3341
Country	:	US
Telephone Number	:	248-505-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 N OLD WOODWARD AVE SUITE 200
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-3341
Country	:	US
Telephone Number	:	248-505-8620
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. MARC SEQUIN
Credential	:
Telephone Number	:	248-505-8620

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	05/25/2023

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