MEDICARE: HEART TO HEART THERAPEUTIC SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740834746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART TO HEART THERAPEUTIC SERVICES INC

Provider Business Mailing Address
First Line	:	1613 BETHANY CHURCH RD
Second Line	:
City	:	BELTON
State	:	SC
Zip	:	29627-9112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 ANDERSON ST STE B
Second Line	:
City	:	BELTON
State	:	SC
Zip	:	29627-2148
Country	:	US
Telephone Number	:	864-933-0793
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	JAN D BANISTER
Credential	:
Telephone Number	:	864-933-0793

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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