Healthcare Provider Details

I. General information

NPI: 1770061962
Provider Name (Legal Business Name): HEALING HEARTS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11625 CHURCH ST
MOUNT MORRIS MI
48458-2016
US

IV. Provider business mailing address

11625 CHURCH ST
MOUNT MORRIS MI
48458-2016
US

V. Phone/Fax

Practice location:
  • Phone: 810-471-7065
  • Fax:
Mailing address:
  • Phone: 810-471-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RACHEL ELIZABETH DEMOINES
Title or Position: OWNER
Credential: LMSW
Phone: 810-471-7065