=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548005648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FACETS OF THE HEART COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2024
-----------------------------------------------------
Last Update Date | 06/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 W RIVERSIDE AVE STE 416
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-1099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-589-2327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5317 S PALOUSE HWY APT G150
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99223-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-319-5882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAMERON R HANNAH
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 509-589-2327
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------