MEDICARE: MENDING HEARTS FAMILY COUNSELING

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	251S00000X	Community/Behavioral Health Agency	37F100173700	NJ

General Provider Information

NPI Number	:	1457692105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDING HEARTS FAMILY COUNSELING

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-0130
Country	:	US
Telephone Number	:	609-234-8050
Fax Number	:	609-499-0685

Provider Business Practice Location Address
First Line	:	60 CATHY LN
Second Line	:	SUITE 101
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-9727
Country	:	US
Telephone Number	:	609-234-8050
Fax Number	:	609-499-0685

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. DANITA S THOMPSON
Credential	:	LMFT
Telephone Number	:	609-234-8050

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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