Provider Demographics
NPI:1528733649
Name:HEATHER MACH COUNSELING LLC
Entity type:Organization
Organization Name:HEATHER MACH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MACH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:651-815-9405
Mailing Address - Street 1:14 7TH AVE N STE 118
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4753
Mailing Address - Country:US
Mailing Address - Phone:651-815-9405
Mailing Address - Fax:
Practice Address - Street 1:14 7TH AVE N STE 118
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4753
Practice Address - Country:US
Practice Address - Phone:651-815-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)