Provider Demographics
NPI:1013386150
Name:INTENTIONAL HEARTS COUNSELING SERVICES
Entity Type:Organization
Organization Name:INTENTIONAL HEARTS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-853-3050
Mailing Address - Street 1:6 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1806 HIGHWAY 35
Practice Address - Street 2:SUITE 203B
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2700
Practice Address - Country:US
Practice Address - Phone:732-853-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00432100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty