Provider Demographics
NPI:1316411531
Name:HEARTFELT THERAPY, LLC
Entity Type:Organization
Organization Name:HEARTFELT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARIS
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNS-CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:715-303-4370
Mailing Address - Street 1:1020 10TH AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-9274
Mailing Address - Country:US
Mailing Address - Phone:715-303-4370
Mailing Address - Fax:715-309-5133
Practice Address - Street 1:1020 10TH AVE STE 117
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9274
Practice Address - Country:US
Practice Address - Phone:715-303-4370
Practice Address - Fax:715-309-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)