Provider Demographics
NPI:1033622436
Name:HEARTWOOD CENTER FOR CHILD AND FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:HEARTWOOD CENTER FOR CHILD AND FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:218-263-1347
Mailing Address - Street 1:202 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1736
Mailing Address - Country:US
Mailing Address - Phone:218-263-1347
Mailing Address - Fax:218-263-3241
Practice Address - Street 1:202 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1736
Practice Address - Country:US
Practice Address - Phone:218-263-1347
Practice Address - Fax:218-263-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2825106H00000X, 261QM0855X
MN21152261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health