Basic Information
| Provider Information | |||||||||
| NPI: | 1295280253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHY MIND COUNSELING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6995 W 48TH ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494129506 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6995 W 48TH ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494129506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313351718 | ||||||||
| FaxNumber: | 2314220022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2016 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS-BAKER | ||||||||
| AuthorizedOfficialFirstName: | SALENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2313351718 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401012362 | MI | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.