Provider Demographics
NPI:1548384530
Name:MT. LAUREL COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:MT. LAUREL COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:856-235-8007
Mailing Address - Street 1:199 6TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9749
Mailing Address - Country:US
Mailing Address - Phone:856-235-8007
Mailing Address - Fax:253-981-1787
Practice Address - Street 1:199 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9749
Practice Address - Country:US
Practice Address - Phone:856-235-8007
Practice Address - Fax:856-627-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00033600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty