Healthcare Provider Details

I. General information

NPI: 1760196885
Provider Name (Legal Business Name): SUPPORTIVE HANDS HEALING MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W GRAND AVE STE 301
BELOIT WI
53511-6259
US

IV. Provider business mailing address

136 W GRAND AVE STE 301
BELOIT WI
53511-6259
US

V. Phone/Fax

Practice location:
  • Phone: 608-346-8315
  • Fax:
Mailing address:
  • Phone: 608-346-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTIN HOPE HOLUB
Title or Position: OWNER
Credential: LPC-IT
Phone: 608-774-5560