Healthcare Provider Details

I. General information

NPI: 1487202743
Provider Name (Legal Business Name): NEW BEGINNINGS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NE 3RD ST # 200H
GRAND RAPIDS MN
55744-2869
US

IV. Provider business mailing address

104 NE 3RD ST # 200H
GRAND RAPIDS MN
55744-2869
US

V. Phone/Fax

Practice location:
  • Phone: 218-259-5566
  • Fax:
Mailing address:
  • Phone: 218-999-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JEAN M HEITZMAN
Title or Position: MENTAL HEALTH PROFESSIONAL
Credential: MSW LICSW
Phone: 218-999-7081