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General NPI Number Information
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NPI Number | 1932575891
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Entity Type | Organization
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Legal Business Name | HEALING LIVES, LLC
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 6600 FRANCE AVE S STE 418
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City | EDINA
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State | MN
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Zip | 55435-1805
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Country | US
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Telephone | 651-315-5254
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 FRANCE AVE S STE 418
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City | EDINA
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State | MN
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Zip | 55435-1805
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Country | US
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Telephone | 651-315-5254
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | KATHY BOISJOLI
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Credential | MA, LPCC
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Telephone | 651-315-5254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1009
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License Number State | MN
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