Healthcare Provider Details

I. General information

NPI: 1174411193
Provider Name (Legal Business Name): HEALING HEADQUARTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 DAUPHIN SQ CONNECTOR STE D
MOBILE AL
36607-2500
US

IV. Provider business mailing address

3090 DAUPHIN SQ CONNECTOR STE D
MOBILE AL
36607-2500
US

V. Phone/Fax

Practice location:
  • Phone: 251-202-3209
  • Fax:
Mailing address:
  • Phone: 251-202-3209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TYLER STOUT
Title or Position: DIRECTOR
Credential:
Phone: 337-315-7927