Organization
MIND-BODY AND INNER-SELF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FELICIA IVEY-TOURE CASAC,LMHC (EXC DIRECTOR)
(718) 362-0615
Entity
Organization
Contact information
Practice address
15206 123RD AVE, JAMAICA, NY 11434-2311
(718) 362-0615
Mailing address
15206 123RD AVE, JAMAICA, NY 11434-2311
(718) 362-0615
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2635
NY
251S00000X
Community/Behavioral Health Agency
2669
NY
251S00000X
Community/Behavioral Health Agency
4419941
NY
Other
Enumeration date
11/01/2008
Last updated
11/01/2008
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