Mia Tanya Stula Kellam, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00041700 Issued in NJ

Practice address

339 W 2ND St
Bound Brook, NJ 08805-1833

Phone

(732) 356-1082

Fax

(732) 356-6327

NPI assigned

May 20, 2008

Last updated

May 20, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1417114240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 W 2ND ST",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051833",
            "telephone_number": "732-356-1082",
            "fax_number": "732-356-6327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 W 2ND ST",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051833",
            "telephone_number": "732-356-1082",
            "fax_number": "732-356-6327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STULA KELLAM",
        "first_name": "MIA TANYA",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00041700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Soden, MD
• Somerset Prosthetics and Orthotics Inc
• Special Abilities Global Network
• Station Pharmacy LLC (Bound Brook Pharmacy)
• Zora Stefanovski, D.M.D
• Lynn S Taylor, LSW
• The Devereux Foundation (Devereux Advanced Behavioral Health)
• The Get Well Center, PC
• Toke Chiropractic Services
• Natalie Helena Toke, DC

• Mental Health Counselor in Bound Brook, NJ
• Providers in Bound Brook, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.