Healthcare Provider Details

I. General information

NPI: 1104365691
Provider Name (Legal Business Name): HEALING HEARTS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

IV. Provider business mailing address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

V. Phone/Fax

Practice location:
  • Phone: 419-528-5993
  • Fax: 567-560-5486
Mailing address:
  • Phone: 419-528-5993
  • Fax: 567-560-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number01-7574
License Number StateOH

VIII. Authorized Official

Name: MS. MAJA ANDERSON
Title or Position: OWNER
Credential:
Phone: 419-528-5993