Provider Demographics
NPI:1801518063
Name:LITTLE BLACK CAT COUNSELING AND HEALING
Entity type:Organization
Organization Name:LITTLE BLACK CAT COUNSELING AND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:385-377-5995
Mailing Address - Street 1:715 E 3900 S STE 103
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2570
Mailing Address - Country:US
Mailing Address - Phone:385-377-5995
Mailing Address - Fax:
Practice Address - Street 1:715 E 3900 S STE 103
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2570
Practice Address - Country:US
Practice Address - Phone:385-377-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty