Provider Demographics
NPI:1750534905
Name:MIND-BODY AND INNER-SELF MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:MIND-BODY AND INNER-SELF MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY-TOURE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CASAC
Authorized Official - Phone:718-362-0615
Mailing Address - Street 1:15206 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2311
Mailing Address - Country:US
Mailing Address - Phone:718-362-0615
Mailing Address - Fax:
Practice Address - Street 1:11929 80TH RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1105
Practice Address - Country:US
Practice Address - Phone:718-362-0615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2579101YM0800X
NY002536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty