Provider Demographics
NPI:1740654417
Name:INSIGHTFUL MIND COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:INSIGHTFUL MIND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:CORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:973-750-4111
Mailing Address - Street 1:36 MIDVALE RD
Mailing Address - Street 2:LOWER LEVEL 5
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1353
Mailing Address - Country:US
Mailing Address - Phone:973-750-4111
Mailing Address - Fax:
Practice Address - Street 1:36 MIDVALE RD
Practice Address - Street 2:LOWER LEVEL 5
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1353
Practice Address - Country:US
Practice Address - Phone:973-750-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00511900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty