Provider Demographics
NPI:1679284335
Name:HEART AND SOUL COUNSELING
Entity Type:Organization
Organization Name:HEART AND SOUL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINEBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-540-4111
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:TAHOE VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:96148-0166
Mailing Address - Country:US
Mailing Address - Phone:619-540-4111
Mailing Address - Fax:530-494-0204
Practice Address - Street 1:7005 N LAKE BLVD # 166
Practice Address - Street 2:
Practice Address - City:TAHOE VISTA
Practice Address - State:CA
Practice Address - Zip Code:96148-9800
Practice Address - Country:US
Practice Address - Phone:619-540-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528208907OtherNPPES