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General NPI Number Information
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NPI Number | 1497359194
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Entity Type | Organization
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Legal Business Name | WHOLEHEARTED HERD COUNSELING, LLC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 242031 COUNTY ROAD Y
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City | ANIWA
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State | WI
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Zip | 54408-5047
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Country | US
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Telephone | 715-200-3838
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Fax | 715-504-8809
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Provider Business Mailing Address
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Address Line | 242031 COUNTY ROAD Y
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City | ANIWA
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State | WI
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Zip | 54408-5047
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Country | US
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Telephone | 715-200-3838
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Fax | 715-504-8809
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | JUSTINE CHRISTAL CLEVELAND
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Credential | LCSW
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Telephone | 715-200-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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