Provider Demographics
NPI:1689096927
Name:MINDFUL MATTERS COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:MINDFUL MATTERS COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHALK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:586-649-8410
Mailing Address - Street 1:9443 NOOK RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4428
Mailing Address - Country:US
Mailing Address - Phone:586-649-8410
Mailing Address - Fax:586-569-2544
Practice Address - Street 1:17937 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4557
Practice Address - Country:US
Practice Address - Phone:586-649-8410
Practice Address - Fax:586-569-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011374101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty