Provider Demographics
NPI:1710579511
Name:GUIDED EPIPHANY INCORPORATED
Entity Type:Organization
Organization Name:GUIDED EPIPHANY INCORPORATED
Other - Org Name:GUIDED EPIPHANY INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/LICENSED MENTAL HEALTH COUNSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-300-8645
Mailing Address - Street 1:1960 EAST TREMONT AVENUE
Mailing Address - Street 2:#1H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5641
Mailing Address - Country:US
Mailing Address - Phone:917-300-8645
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVENUE
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:917-300-8645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty