Provider Demographics
NPI:1164912879
Name:MIND AND SPIRIT COUNSELING LLC
Entity Type:Organization
Organization Name:MIND AND SPIRIT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIZY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-859-0030
Mailing Address - Street 1:44444 MOUND RD STE 620
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1354
Mailing Address - Country:US
Mailing Address - Phone:586-859-0030
Mailing Address - Fax:
Practice Address - Street 1:44444 MOUND RD STE 620
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1354
Practice Address - Country:US
Practice Address - Phone:586-859-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087898104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty