Provider Demographics
NPI:1114575982
Name:INDUSTRIOUS HEALING LLC
Entity Type:Organization
Organization Name:INDUSTRIOUS HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACONIC
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-219-7620
Mailing Address - Street 1:4908 ALDRICH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3533
Mailing Address - Country:US
Mailing Address - Phone:612-219-7620
Mailing Address - Fax:
Practice Address - Street 1:10501 WAYZATA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1519
Practice Address - Country:US
Practice Address - Phone:612-219-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)