=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386172633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING TRANSFORMATIONS COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2017
-----------------------------------------------------
Last Update Date | 04/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 CEDAR ST STE 230
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-522-0718
-----------------------------------------------------
Fax | 320-262-8395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 CEDAR ST STE 230
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-522-0718
-----------------------------------------------------
Fax | 320-262-8395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/PRESIDENT
-----------------------------------------------------
Name | PAMELA JEAN KUBESH
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 320-522-0718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 9111
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------