MEDICARE: MIND, BODY AND SOUL 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1790404317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND, BODY AND SOUL COUNSELING LLC

Provider Business Mailing Address
First Line	:	491 BALTIMORE PIKE STE 1134
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-3810
Country	:	US
Telephone Number	:	484-938-8495
Fax Number	:

Provider Business Practice Location Address
First Line	:	4022 BRUNSWICK AVE
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-3406
Country	:	US
Telephone Number	:	484-938-8495
Fax Number	:

Authorized Official
Title or Position	:	HOLISTIC PSYCHOTHERAPIST
Name	:	MRS. BRANDELYN MARTINA HANKINS
Credential	:	LPC
Telephone Number	:	484-938-8495

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/25/2022

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