MEDICARE: BEUTIFUL MIND COUNSELING SERVICES, 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	101YM0800X	Mental Health Counselor	PC002949	PA

General Provider Information

NPI Number	:	1386094324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEUTIFUL MIND COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1 WASHINGTON ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-2816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WASHINGTON ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-2816
Country	:	US
Telephone Number	:	570-426-7150
Fax Number	:	570-426-9484

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	TERESA BARRY
Credential	:	LPC
Telephone Number	:	570-426-7150

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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