Healthcare Provider Details

I. General information

NPI: 1083177877
Provider Name (Legal Business Name): THE CENTER FOR SOMATIC HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W 17TH ST STE 4
BLOOMINGTON IN
47404-3374
US

IV. Provider business mailing address

1456 S STATE ROAD 446
BLOOMINGTON IN
47401-8800
US

V. Phone/Fax

Practice location:
  • Phone: 812-322-6714
  • Fax:
Mailing address:
  • Phone: 812-322-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SHEIKH
Title or Position: OWNER
Credential: LCSW
Phone: 812-322-6714