Provider Demographics
NPI:1487334850
Name:MIMBS COUNSELING LLC
Entity type:Organization
Organization Name:MIMBS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIMBS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, C-DBT
Authorized Official - Phone:423-243-0088
Mailing Address - Street 1:2288 GUNBARREL RD.
Mailing Address - Street 2:STE. 154 #232
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3492
Mailing Address - Country:US
Mailing Address - Phone:423-243-0088
Mailing Address - Fax:
Practice Address - Street 1:4321 FOREST PLAZA DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5017
Practice Address - Country:US
Practice Address - Phone:423-243-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health