Provider Demographics
NPI:1053024737
Name:ALPHA MIND & MUSCLE
Entity type:Organization
Organization Name:ALPHA MIND & MUSCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER LEVEL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA, LPC
Authorized Official - Phone:734-318-1999
Mailing Address - Street 1:43643 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4573
Mailing Address - Country:US
Mailing Address - Phone:734-318-1999
Mailing Address - Fax:
Practice Address - Street 1:43643 CEDARHURST DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-4573
Practice Address - Country:US
Practice Address - Phone:734-318-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty