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General NPI Number Information
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NPI Number | 1649780347
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEALING COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 10/07/2017
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 13508 COUNTY 1
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City | CAVALIER
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State | ND
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Zip | 58220-9421
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Country | US
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Telephone | 701-520-3655
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Fax | 701-265-4628
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Provider Business Mailing Address
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Address Line | 13508 COUNTY 1
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City | CAVALIER
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State | ND
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Zip | 58220-9421
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Country | US
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Telephone | 701-520-3655
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Fax | 701-265-4628
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. ANGELA MARIE LONGTIN
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Credential | LPCC
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Telephone | 701-922-0628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 469-12-1-01-187
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License Number State | ND
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