Provider Demographics
NPI:1174296438
Name:MOVING MOUNTAINS LLC
Entity Type:Organization
Organization Name:MOVING MOUNTAINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:480-431-1589
Mailing Address - Street 1:415 LAKE SHORE DR NE APT 104
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4682
Mailing Address - Country:US
Mailing Address - Phone:480-431-1589
Mailing Address - Fax:
Practice Address - Street 1:415 LAKE SHORE DR NE APT 104
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4682
Practice Address - Country:US
Practice Address - Phone:480-431-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty