Provider Demographics
NPI:1013449073
Name:HARTLEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:HARTLEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-554-3740
Mailing Address - Street 1:6607 18TH AVE S
Mailing Address - Street 2:101
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2784
Mailing Address - Country:US
Mailing Address - Phone:612-554-3740
Mailing Address - Fax:651-344-4406
Practice Address - Street 1:6607 18TH AVE S
Practice Address - Street 2:101
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2784
Practice Address - Country:US
Practice Address - Phone:612-554-3740
Practice Address - Fax:651-344-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15674251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health