NPI |
1215508627 |
The country code in the location address of the provider being identified. |
Entity Type Code |
2 |
The telephone number associated with the location address of the provider being identified. |
Employer Identification Number EIN |
|
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Organization Name Legal Business Name |
HEART AND MIND COUNSELING, LLC |
The date that a record was last updated or changed. |
Provider First Line Business Practice Location Address |
135 N OLD WOODWARD AVE SUITE 200 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BIRMINGHAM |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MI |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
480093341 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2485058620 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
7/7/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
5/25/2023 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
SEQUIN |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
MARC |
The first name of the authorized official. |
Authorized Official Title or Position |
CHIEF EXECUTIVE OFFICER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
2485058620 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
1041C0700X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
NPI Certification Date |
5/25/2023 |
|