Provider Demographics
NPI:1396413985
Name:INNOVATIVE MINDS COUNSELING LLC
Entity Type:Organization
Organization Name:INNOVATIVE MINDS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-706-9836
Mailing Address - Street 1:4601 OAK CIR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3347
Mailing Address - Country:US
Mailing Address - Phone:484-706-9836
Mailing Address - Fax:
Practice Address - Street 1:4601 OAK CIR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3347
Practice Address - Country:US
Practice Address - Phone:484-706-9836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)