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General NPI Number Information
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NPI Number | 1316573819
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Entity Type | Organization
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Legal Business Name | HEALING HEARTS MENTAL HEALTH THERAPY
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 212 S 11TH ST STE 5
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4000
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Country | US
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Telephone | 208-651-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 212 S 11TH ST STE 5
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4000
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Country | US
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Telephone | 208-651-9400
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KIMBERLY LYNN SHELDEN
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Credential | LCSW
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Telephone | 208-651-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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