Healthcare Provider Details

I. General information

NPI: 1235054040
Provider Name (Legal Business Name): WAVES OF HEALING THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16630 N DALE MABRY HWY
TAMPA FL
33618-1400
US

IV. Provider business mailing address

16630 N DALE MABRY HWY
TAMPA FL
33618-1400
US

V. Phone/Fax

Practice location:
  • Phone: 628-245-5181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY BOUSQUET
Title or Position: OWNER
Credential: LMHC
Phone: 860-859-7976