Provider Demographics
NPI:1215399548
Name:HEARTLAND WELLNESS LLC
Entity Type:Organization
Organization Name:HEARTLAND WELLNESS LLC
Other - Org Name:HEARTLAND WELLNESS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:614-937-4365
Mailing Address - Street 1:1019 S ALKIRE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3111
Mailing Address - Country:US
Mailing Address - Phone:303-325-5617
Mailing Address - Fax:
Practice Address - Street 1:7596 W JEWELL AVE STE 303
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6839
Practice Address - Country:US
Practice Address - Phone:303-325-5617
Practice Address - Fax:720-368-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty