=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073484663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORANGE HEART HEALING, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 178 SUMMIT AVE APT 305
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-995-2509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 178 SUMMIT AVE APT 305
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-995-2509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO AND PSYCHOTHERAPIST
-----------------------------------------------------
Name | ANTONIO TOMAS GONZALES OGAS
-----------------------------------------------------
Credential | LICSW, LCSW
-----------------------------------------------------
Telephone | 415-418-4126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------