Organization Name: | INSIGHTFUL MIND COUNSELING SERVICES, LLC |
NPI Number: | 1740654417 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROY STEPHAN CORSON (OWNER/ CLINICIAN) |
Mailing Address: | 36 Midvale Rd Lower Level 5 Mountain Lakes |
State: | NJ US |
Postal Code: | 070461353 |
Phone Number: | 9737504111 |
Fax Number: | |
NPI Enumeration Date: | 11/18/2015 |
NPI Last Update Date: | 11/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 37PC00511900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |