| King Of Hearts Life Enhancement Services, Llc | |
|
522 Brick Blvd Brick NJ 08723-6089 | |
| (732) 240-2545 | |
| (732) 475-6265 |
| Full Name | King Of Hearts Life Enhancement Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 522 Brick Blvd, Brick, New Jersey |
| Authorized Official Name and Position | Tara Michelle King (DIRECTOR) |
| Authorized Official Contact | 7322402545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| King Of Hearts Life Enhancement Services, Llc 522 Brick Blvd Brick NJ 08723-6089 Ph: (732) 240-2545 | King Of Hearts Life Enhancement Services, Llc 522 Brick Blvd Brick NJ 08723-6089 Ph: (732) 240-2545 |
| NPI Number | 1538551072 |
|---|---|
| Provider Enumeration Date | 02/20/2015 |
| Last Update Date | 02/20/2015 |
| Medicare PECOS PAC ID | 8123329174 |
|---|---|
| Medicare Enrollment ID | O20240709003351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538551072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 37LC00034800 (New Jersey) | Primary |
| 101YP2500X | Counselor - Professional | 37PC00161400 (New Jersey) | Secondary |
| Provider Name | Tara M King |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1194750307 PECOS PAC ID: 1254434087 Enrollment ID: I20240711000396 |
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