Provider Demographics
NPI:1053852046
Name:TIES THAT BIND HOLISTIC COUNSELING
Entity type:Organization
Organization Name:TIES THAT BIND HOLISTIC COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:P
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:517-449-9223
Mailing Address - Street 1:3815 W SAINT JOSEPH ST
Mailing Address - Street 2:STE. B301
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3666
Mailing Address - Country:US
Mailing Address - Phone:517-449-9223
Mailing Address - Fax:
Practice Address - Street 1:1717 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4906
Practice Address - Country:US
Practice Address - Phone:517-449-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015732251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health