Provider Demographics
NPI:1346649803
Name:'YOUR BEAUTIFUL MIND' COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:'YOUR BEAUTIFUL MIND' COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LEONE
Authorized Official - Last Name:GASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMSW LPC
Authorized Official - Phone:810-630-6784
Mailing Address - Street 1:6201 MILLER RD STE B
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1598
Mailing Address - Country:US
Mailing Address - Phone:810-630-6784
Mailing Address - Fax:810-644-7138
Practice Address - Street 1:6201 MILLER RD STE B
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1598
Practice Address - Country:US
Practice Address - Phone:810-630-6784
Practice Address - Fax:810-644-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty