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General NPI Number Information
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NPI Number | 1720734270
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Entity Type | Organization
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Legal Business Name | NAMASTE HOLISTIC COUNSELING, LLC
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 2626 N STATE ROAD 39 STE 4
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City | LA PORTE
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State | IN
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Zip | 46350-2074
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Country | US
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Telephone | 574-300-9702
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Fax |
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Provider Business Mailing Address
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Address Line | 731 E 3RD ST
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City | MISHAWAKA
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State | IN
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Zip | 46544-2238
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Country | US
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Telephone | 574-300-9702
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARILYN H DRAPER
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Credential | LMSW
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Telephone | 574-300-9702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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