Provider Demographics
NPI:1609367648
Name:MUSE IC LLC
Entity Type:Organization
Organization Name:MUSE IC LLC
Other - Org Name:RESONANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-403-6148
Mailing Address - Street 1:310 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1818
Mailing Address - Country:US
Mailing Address - Phone:706-403-6148
Mailing Address - Fax:
Practice Address - Street 1:310 W LINE ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1818
Practice Address - Country:US
Practice Address - Phone:706-403-6148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009243101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty