Provider Demographics
NPI:1881046258
Name:HEALING WATERS RECOVERY COUNSELING
Entity type:Organization
Organization Name:HEALING WATERS RECOVERY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ZAMASTIL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:952-393-1987
Mailing Address - Street 1:6954 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1159
Mailing Address - Country:US
Mailing Address - Phone:952-393-1987
Mailing Address - Fax:
Practice Address - Street 1:6954 W 84TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1159
Practice Address - Country:US
Practice Address - Phone:952-393-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2007251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health