Provider Demographics
NPI:1558837567
Name:EMBODIED MIND MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:EMBODIED MIND MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:347-991-4946
Mailing Address - Street 1:111 JOHN ST RM 2400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:917-725-8914
Practice Address - Street 1:111 JOHN ST RM 2400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3013
Practice Address - Country:US
Practice Address - Phone:347-991-4946
Practice Address - Fax:917-725-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty