1275236705 NPI number — HEALING YOUR MIND COUNSELING

Table of content: (NPI 1275236705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275236705 NPI number — HEALING YOUR MIND COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING YOUR MIND COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275236705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N510 BUCKINGHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT ATKINSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53538-9794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-542-5044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT ATKINSON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53538-2264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-472-9591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALTER
Authorized Official First Name:
DANA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
920-542-5044

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)