1952980252 NPI number — BEAUTIFUL MINDS COUNSELING SERVICES

Table of content: (NPI 1952980252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952980252 NPI number — BEAUTIFUL MINDS COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUTIFUL MINDS COUNSELING SERVICES
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:
BEAUTIFUL MINDS COUNSELING SERVICES
Provider Other Organization Name Type Code:
3
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:
1952980252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 MORRISON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24740-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
681-282-5678
Provider Business Mailing Address Fax Number:
304-362-8244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 MORRISON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
681-282-5678
Provider Business Practice Location Address Fax Number:
304-362-8244
Provider Enumeration Date:
04/05/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CADLE
Authorized Official First Name:
MISTY
Authorized Official Middle Name:
AMBER
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
681-282-5678

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 86-3040824 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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