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General NPI Number Information
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NPI Number | 1396480810
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Entity Type | Organization
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Legal Business Name | THE WHOLEHEARTED CLASSOOM
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 1101 BROAD ST # 165B
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1790
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Country | US
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Telephone | 269-470-6878
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Fax |
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Provider Business Mailing Address
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Address Line | 2161 HANLEY RD N
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2915
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Country | US
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Telephone | 269-470-6878
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/OWNER
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Name | MEGAN HINES
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Credential | LPC
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Telephone | 269-470-6878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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