Provider Demographics
NPI:1104314269
Name:OPEN HEART COUNSELING PLC
Entity type:Organization
Organization Name:OPEN HEART COUNSELING PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-310-7091
Mailing Address - Street 1:160 RIVER ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3662
Mailing Address - Country:US
Mailing Address - Phone:802-310-7091
Mailing Address - Fax:
Practice Address - Street 1:160 RIVER ST UNIT 103
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3662
Practice Address - Country:US
Practice Address - Phone:802-310-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00846501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1027825Medicaid