Provider Demographics
NPI:1760196885
Name:SUPPORTIVE HANDS HEALING MINDS, LLC
Entity Type:Organization
Organization Name:SUPPORTIVE HANDS HEALING MINDS, LLC
Other - Org Name:BELOIT PSYCHOTHERAPY AND COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:HOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-IT
Authorized Official - Phone:608-774-5560
Mailing Address - Street 1:136 W GRAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6259
Mailing Address - Country:US
Mailing Address - Phone:608-346-8315
Mailing Address - Fax:
Practice Address - Street 1:136 W GRAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6259
Practice Address - Country:US
Practice Address - Phone:608-346-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225763204Medicaid