Provider Demographics
NPI:1003042656
Name:DIVINE HOPE COUNSELING
Entity Type:Organization
Organization Name:DIVINE HOPE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:320-231-9763
Mailing Address - Street 1:328 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3475
Mailing Address - Country:US
Mailing Address - Phone:320-231-9763
Mailing Address - Fax:320-235-0334
Practice Address - Street 1:328 3RD ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3475
Practice Address - Country:US
Practice Address - Phone:320-231-9763
Practice Address - Fax:320-235-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1053421324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1I52DIOtherBLUE CROSS BLUE SHIELD