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General NPI Number Information
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NPI Number | 1265909634
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Entity Type | Individual
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Provider Name | HEATHER J LIDHOLM MA LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 8120 PENN AVE S STE 500H
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1367
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Country | US
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Telephone | 612-383-7201
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Fax |
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Provider Business Mailing Address
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Address Line | 8120 PENN AVE S STE 500H
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1367
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Country | US
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Telephone | 612-383-7201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3760
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License Number State | MN
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