Healthcare Provider Details

I. General information

NPI: 1871410563
Provider Name (Legal Business Name): HEARTLAND COUNSELING AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAKE ST S STE 103
BIG LAKE MN
55309-9512
US

IV. Provider business mailing address

PO BOX 94
MONTICELLO MN
55362-0094
US

V. Phone/Fax

Practice location:
  • Phone: 612-440-0699
  • Fax:
Mailing address:
  • Phone: 612-440-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MOLLY LIESER
Title or Position: COUNSELOR
Credential: MA, LPCC
Phone: 612-440-0699