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General NPI Number Information
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NPI Number | 1215399548
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Entity Type | Organization
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Legal Business Name | HEARTLAND WELLNESS LLC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 7596 W JEWELL AVE STE 303
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City | LAKEWOOD
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State | CO
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Zip | 80232-6839
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Country | US
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Telephone | 303-325-5617
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Fax | 720-368-5157
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Provider Business Mailing Address
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Address Line | 1019 S ALKIRE ST
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City | LAKEWOOD
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State | CO
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Zip | 80228-3111
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Country | US
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Telephone | 303-325-5617
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUJATHA REDDY
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Credential | LPC
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Telephone | 614-937-4365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0012340
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License Number State | CO
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