Provider Demographics
NPI:1043505373
Name:HEALING MOMENTS COUNSELING LLC
Entity type:Organization
Organization Name:HEALING MOMENTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ROSE-PENKALA
Authorized Official - Last Name:MASSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC
Authorized Official - Phone:651-208-9533
Mailing Address - Street 1:1262 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8913
Mailing Address - Country:US
Mailing Address - Phone:763-732-3351
Mailing Address - Fax:763-322-5026
Practice Address - Street 1:1262 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8913
Practice Address - Country:US
Practice Address - Phone:763-732-3351
Practice Address - Fax:763-322-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health