Provider Demographics
NPI:1548811292
Name:MIIBOSO CONSULTANTS, LLC
Entity type:Organization
Organization Name:MIIBOSO CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:225-993-1535
Mailing Address - Street 1:901 W BARDIN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6000
Mailing Address - Country:US
Mailing Address - Phone:682-323-5402
Mailing Address - Fax:682-323-5402
Practice Address - Street 1:901 W BARDIN RD STE 202
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6000
Practice Address - Country:US
Practice Address - Phone:682-323-5402
Practice Address - Fax:682-323-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty