Provider Demographics
NPI:1518639285
Name:HEATHERS COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:HEATHERS COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONWAY-HAEHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:320-247-5202
Mailing Address - Street 1:2700 1ST ST N STE 106B
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4583
Mailing Address - Country:US
Mailing Address - Phone:320-247-5202
Mailing Address - Fax:
Practice Address - Street 1:2700 1ST ST N STE 106B
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4583
Practice Address - Country:US
Practice Address - Phone:320-247-5202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty