Healthcare Provider Details

I. General information

NPI: 1134082902
Provider Name (Legal Business Name): HEALING FOR YOUR SOUL THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16649 OAK PARK AVE STE H
TINLEY PARK IL
60477-1843
US

IV. Provider business mailing address

16649 OAK PARK AVE STE H
TINLEY PARK IL
60477-1843
US

V. Phone/Fax

Practice location:
  • Phone: 708-249-7301
  • Fax: 708-249-7302
Mailing address:
  • Phone: 708-249-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LATASHA NICOLE LYONS
Title or Position: OWNER
Credential:
Phone: 332-330-3903