Healthcare Provider Details

I. General information

NPI: 1790496669
Provider Name (Legal Business Name): HEALING HEARTS MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 GREENHEAD RD
CHIPLEY FL
32428-6512
US

IV. Provider business mailing address

2624 GREENHEAD RD
CHIPLEY FL
32428-6512
US

V. Phone/Fax

Practice location:
  • Phone: 850-624-8626
  • Fax:
Mailing address:
  • Phone: 850-624-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY J STAEBELL
Title or Position: DIRECTOR
Credential: LMFT & LMHC
Phone: 850-624-8626