Provider Demographics
NPI:1851962732
Name:EASE OF MIND COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EASE OF MIND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARITA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:812-820-3061
Mailing Address - Street 1:639 N SHEA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-8132
Mailing Address - Country:US
Mailing Address - Phone:812-820-3061
Mailing Address - Fax:
Practice Address - Street 1:639 N SHEA RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-8132
Practice Address - Country:US
Practice Address - Phone:812-820-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043827991OtherNPI TYPE 1
IN39003807AOtherPROFESSIONAL LICENSE