Provider Demographics
NPI:1275967374
Name:ALLIANCE FOR HEALING PA
Entity Type:Organization
Organization Name:ALLIANCE FOR HEALING PA
Other - Org Name:AHEARTT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, CPT, CSAT
Authorized Official - Phone:651-470-4671
Mailing Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3697
Mailing Address - Country:US
Mailing Address - Phone:651-493-8150
Mailing Address - Fax:651-493-9335
Practice Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-493-8150
Practice Address - Fax:651-493-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X, 106H00000X
MN1967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1275967374Medicaid