Provider Demographics
NPI:1801643523
Name:UNLOCKING BEAUTY, LLC
Entity type:Organization
Organization Name:UNLOCKING BEAUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:218-366-0580
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:MN
Mailing Address - Zip Code:56570-0322
Mailing Address - Country:US
Mailing Address - Phone:218-366-0580
Mailing Address - Fax:
Practice Address - Street 1:201 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1410
Practice Address - Country:US
Practice Address - Phone:218-366-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)