Provider Demographics
NPI:1053805945
Name:THIRD EYE COUNSELING INC.
Entity type:Organization
Organization Name:THIRD EYE COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MH & SA COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GULOWSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC, CCS
Authorized Official - Phone:207-370-9397
Mailing Address - Street 1:2821 MARIAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARIAVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04605-7205
Mailing Address - Country:US
Mailing Address - Phone:207-370-9397
Mailing Address - Fax:
Practice Address - Street 1:27 STATE ST STE 38
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5141
Practice Address - Country:US
Practice Address - Phone:207-370-9397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC16682101Y00000X, 101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty