Provider Demographics
NPI:1891435558
Name:OPEN MINDS COUNSELING LLC
Entity Type:Organization
Organization Name:OPEN MINDS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AISLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-416-1860
Mailing Address - Street 1:1120 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2300
Mailing Address - Country:US
Mailing Address - Phone:601-416-1860
Mailing Address - Fax:
Practice Address - Street 1:1120 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2300
Practice Address - Country:US
Practice Address - Phone:601-416-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty