MEDICARE: HEALING THROUGH PSYCHOTHERAPY, INC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1598305146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING THROUGH PSYCHOTHERAPY, INC

Provider Business Mailing Address
First Line	:	5015 BIRCH ST
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2162
Country	:	US
Telephone Number	:	949-887-4166
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 BIRCH ST
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2162
Country	:	US
Telephone Number	:	949-887-4166
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ELLEN R VAN ECK
Credential	:	PHD
Telephone Number	:	949-887-4166

Provider Enumeration Date	:	01/12/2020
Last Update Date	:	08/10/2021

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