Provider Demographics
NPI:1144840653
Name:MENDING HEARTS COUNSELING AND CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:MENDING HEARTS COUNSELING AND CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBIE-JO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALZANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-937-1321
Mailing Address - Street 1:193 KID LONG RD
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-8507
Mailing Address - Country:US
Mailing Address - Phone:814-937-1321
Mailing Address - Fax:
Practice Address - Street 1:113 SUMNER ST
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-2118
Practice Address - Country:US
Practice Address - Phone:814-937-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty