Provider Demographics
NPI:1730635400
Name:MUSE COUNSELING, LLC
Entity Type:Organization
Organization Name:MUSE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONTAKIA
Authorized Official - Middle Name:PRINCESS
Authorized Official - Last Name:DANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-234-7999
Mailing Address - Street 1:627 RIVER BEND WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5838
Mailing Address - Country:US
Mailing Address - Phone:678-234-7999
Mailing Address - Fax:
Practice Address - Street 1:113 MOUNTAIN BROOK DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9057
Practice Address - Country:US
Practice Address - Phone:678-234-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009109305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization