Provider Demographics
NPI:1003418161
Name:MENTAL HEALTH COUNSELING & LIFE COACHING CORPORATION
Entity Type:Organization
Organization Name:MENTAL HEALTH COUNSELING & LIFE COACHING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SATYSHUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-279-5043
Mailing Address - Street 1:3401 GREENWAY UNIT 103
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2601
Mailing Address - Country:US
Mailing Address - Phone:410-279-5043
Mailing Address - Fax:
Practice Address - Street 1:3401 GREENWAY UNIT 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2601
Practice Address - Country:US
Practice Address - Phone:410-279-5043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty