Healthcare Provider Details

I. General information

NPI: 1821796079
Provider Name (Legal Business Name): HEAL HER HOLISTIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 MILLENNIUM PKWY STE 122
BRANDON FL
33511-3891
US

IV. Provider business mailing address

2430 SAGEMONT DR
BRANDON FL
33511-1744
US

V. Phone/Fax

Practice location:
  • Phone: 813-812-9246
  • Fax:
Mailing address:
  • Phone: 813-812-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANNEDRA EBANKS
Title or Position: OWNER
Credential: LMHC
Phone: 813-812-9246