Provider Demographics
NPI:1750909644
Name:MIND MEETS MOVEMENT COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:MIND MEETS MOVEMENT COUNSELING SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIUSCIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:516-500-3528
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-0072
Mailing Address - Country:US
Mailing Address - Phone:917-415-4562
Mailing Address - Fax:
Practice Address - Street 1:381 SUNRISE HWY STE 602
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3006
Practice Address - Country:US
Practice Address - Phone:516-500-3528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)