Provider Demographics
NPI:1093335911
Name:MIND OVER MATTER COUNSELING
Entity Type:Organization
Organization Name:MIND OVER MATTER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KHALEA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-574-5809
Mailing Address - Street 1:12160 KINLOCH
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25600 WOODWARD AVE STE 204
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0945
Practice Address - Country:US
Practice Address - Phone:313-574-5809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health