Provider Demographics
NPI:1669049581
Name:FREE AT HEART ONLINE THERAPY LICENSED CLINICAL SOCIAL WORKER PC
Entity type:Organization
Organization Name:FREE AT HEART ONLINE THERAPY LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-591-5915
Mailing Address - Street 1:1237 MOCKING BIRD LN
Mailing Address - Street 2:
Mailing Address - City:ECLECTIC
Mailing Address - State:AL
Mailing Address - Zip Code:36024-6368
Mailing Address - Country:US
Mailing Address - Phone:530-591-5915
Mailing Address - Fax:
Practice Address - Street 1:140 E COMMONWEALTH AVE STE 208
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1905
Practice Address - Country:US
Practice Address - Phone:530-591-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty