Provider Demographics
NPI:1629571005
Name:ONE LOVE:HARMONIZING MIND, BODY, SPIRIT
Entity Type:Organization
Organization Name:ONE LOVE:HARMONIZING MIND, BODY, SPIRIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFACKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-IT
Authorized Official - Phone:920-221-6112
Mailing Address - Street 1:1366 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1504
Mailing Address - Country:US
Mailing Address - Phone:920-221-6112
Mailing Address - Fax:
Practice Address - Street 1:1366 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1504
Practice Address - Country:US
Practice Address - Phone:920-221-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center