Provider Demographics
NPI:1215253588
Name:MENTAL HEALTH COUNSELING SERVICE
Entity type:Organization
Organization Name:MENTAL HEALTH COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEEND
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSW
Authorized Official - Phone:732-842-4433
Mailing Address - Street 1:461 BUCHANAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5356
Mailing Address - Country:US
Mailing Address - Phone:732-842-4433
Mailing Address - Fax:
Practice Address - Street 1:461 BUCHANAN BLVD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5356
Practice Address - Country:US
Practice Address - Phone:732-842-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INB4745101YA0400X
NJ44SW047277001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty