MEDICARE: HEALTHY MINDS MENTAL HEALTH COUNSELING SERVICES PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295482453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MINDS MENTAL HEALTH COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	2120 E SERGEANT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1729
Country	:	US
Telephone Number	:	646-327-2059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 E SERGEANT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1729
Country	:	US
Telephone Number	:	646-327-2059
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JUAN PERALTA
Credential	:
Telephone Number	:	646-327-2059

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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