Healthcare Provider Details

I. General information

NPI: 1083358709
Provider Name (Legal Business Name): RAISING HOPE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 E CENTER ST
WARSAW IN
46580-3322
US

IV. Provider business mailing address

734 E CENTER ST
WARSAW IN
46580-3322
US

V. Phone/Fax

Practice location:
  • Phone: 612-210-4347
  • Fax:
Mailing address:
  • Phone: 612-210-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE CAMPBELL
Title or Position: LMFT/OWNER
Credential:
Phone: 612-210-4347