Healthcare Provider Details

I. General information

NPI: 1043737570
Provider Name (Legal Business Name): HEALING HOOVES PSYCHOTHERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 SW 180TH TER
SOUTHWEST RANCHES FL
33331-1611
US

IV. Provider business mailing address

3901 SHADY RIDGE RD
FORT LAUDERDALE FL
33312-6205
US

V. Phone/Fax

Practice location:
  • Phone: 954-907-6862
  • Fax: 954-907-6862
Mailing address:
  • Phone: 954-907-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMT3092
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMT3092
License Number StateFL

VIII. Authorized Official

Name: MS. SARAH LYNN CHAMBERLIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 954-907-6862