Healthcare Provider Details

I. General information

NPI: 1750077202
Provider Name (Legal Business Name): TIA MARIE HEIMER MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA MARIE ANDERSON MA

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 BASS LAKE RD STE 255
NEW HOPE MN
55428-3019
US

IV. Provider business mailing address

7625 METRO BLVD STE 200
MINNEAPOLIS MN
55439-3057
US

V. Phone/Fax

Practice location:
  • Phone: 763-225-4052
  • Fax:
Mailing address:
  • Phone: 612-715-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: