Provider Demographics
NPI:1295300150
Name:MINDFULLY ACTIVE KARVER COUNSELING & WELLNESS LLC
Entity type:Organization
Organization Name:MINDFULLY ACTIVE KARVER COUNSELING & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:AIDA
Authorized Official - Last Name:KARVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR-BC
Authorized Official - Phone:609-513-2972
Mailing Address - Street 1:329 E JIMMIE LEEDS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4110
Mailing Address - Country:US
Mailing Address - Phone:609-365-0778
Mailing Address - Fax:
Practice Address - Street 1:329 E JIMMIE LEEDS RD STE 206
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4110
Practice Address - Country:US
Practice Address - Phone:609-365-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1003421124OtherATNEA, BCBS, UNITED HEALTH CARE