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NPI Code Detail

MEDICARE: NEUTRAL GROUND HEALING COLLECTIVE, LLC

MEDICARE: NEUTRAL GROUND HEALING COLLECTIVE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor
2103TC0700XClinical Psychologist
3104100000XSocial Worker
41041C0700XClinical Social Worker
5163WP0808XPsychiatric/Mental Health Registered Nurse
6363LP0808XPsychiatric/Mental Health Nurse Practitioner
7261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1437959376
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUTRAL GROUND HEALING COLLECTIVE, LLC
Provider Business Mailing Address
First Line : 32 W ALLENS LN
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-1637
Country : US
Telephone Number : 267-574-6061
Fax Number :
Provider Business Practice Location Address
First Line : 500 N 13TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19123-3955
Country : US
Telephone Number : 267-636-6008
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : KELLY JUDE
Credential : LCSW
Telephone Number : 267-291-4385
Provider Enumeration Date : 03/18/2025
Last Update Date : 05/21/2025

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