MEDICARE: HEALING HEART THERAPY SERVICES, 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1558205765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HEART THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	12777 FOREST HILL BLVD STE 1502
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4775
Country	:	US
Telephone Number	:	561-628-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	12777 FOREST HILL BLVD STE 1502
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4775
Country	:	US
Telephone Number	:	561-628-1223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARI K BOULDIN
Credential	:	LMFT
Telephone Number	:	561-628-1223

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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