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General NPI Number Information
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NPI Number | 1881046258
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Entity Type | Organization
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Legal Business Name | HEALING WATERS RECOVERY COUNSELING
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 6954 W 84TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55438-1159
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Country | US
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Telephone | 952-393-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 6954 W 84TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55438-1159
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Country | US
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Telephone | 952-393-1987
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW JAMES ZAMASTIL
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Credential | LMFT
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Telephone | 952-393-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2007
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License Number State | MN
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