Provider Demographics
NPI:1255906780
Name:GRATEFUL HEART COUNSELING LLC
Entity type:Organization
Organization Name:GRATEFUL HEART COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUMBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-522-1411
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MN
Mailing Address - Zip Code:55332-0396
Mailing Address - Country:US
Mailing Address - Phone:320-522-1411
Mailing Address - Fax:
Practice Address - Street 1:115 LITCHFIELD AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3476
Practice Address - Country:US
Practice Address - Phone:320-522-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700972320Medicaid