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NPI Code Detail

MEDICARE: HEALING & RESTORATION CONSULTING LLC

MEDICARE: HEALING & RESTORATION CONSULTING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1841650439
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALING & RESTORATION CONSULTING LLC
Provider Business Mailing Address
First Line : 18397 CHENNAULT WAY
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55346-1124
Country : US
Telephone Number : 612-916-0945
Fax Number : 952-388-2526
Provider Business Practice Location Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 612-216-1114
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : TRINA N GIVENS-HENRY
Credential : LICSW
Telephone Number : 612-916-0945
Provider Enumeration Date : 02/25/2016
Last Update Date : 10/17/2019

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Directions to “HEALING & RESTORATION CONSULTING LLC ” Practice Location

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