Provider Demographics
NPI:1740553080
Name:MIND AND SPIRIT COUNSELING AND EDUCATION SERVICES LLC.
Entity type:Organization
Organization Name:MIND AND SPIRIT COUNSELING AND EDUCATION SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:STOBIE
Authorized Official - Suffix:
Authorized Official - Credentials:PCC, NCC
Authorized Official - Phone:937-520-8437
Mailing Address - Street 1:3195 DAYTON XENIA RD, PMB 108, STE 900
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6390
Mailing Address - Country:US
Mailing Address - Phone:937-520-8437
Mailing Address - Fax:937-320-9630
Practice Address - Street 1:1407 NEW WAY DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6925
Practice Address - Country:US
Practice Address - Phone:937-520-8437
Practice Address - Fax:937-320-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0501350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty