Provider Demographics
NPI:1437658606
Name:HIDDING, THEODORE ROBERT (LPCC)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ROBERT
Last Name:HIDDING
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13968 CYPRESS DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-5904
Mailing Address - Country:US
Mailing Address - Phone:218-454-1082
Mailing Address - Fax:
Practice Address - Street 1:13968 CYPRESS DR STE 1A
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-454-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health