1295187425 NPI number — MIND MATTERS COACHING, COUNSELING, & PSYCHOLOGICAL ASSOCIATES LLC

Table of content: (NPI 1295187425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295187425 NPI number — MIND MATTERS COACHING, COUNSELING, & PSYCHOLOGICAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIND MATTERS COACHING, COUNSELING, & PSYCHOLOGICAL ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295187425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2208 QUARRY DR
Provider Second Line Business Mailing Address:
VAN REED OFFICE CENTER, SUITE #200
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19609-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-563-2052
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2209 QUARRY DR STE A10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19609-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-696-4631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUNDY
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
OWNER, SOLE PROPRIETOR
Authorized Official Telephone Number:
610-301-8360

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS018003 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: CW016069 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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