Healthcare Provider Details

I. General information

NPI: 1265210439
Provider Name (Legal Business Name): THE HEALING VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 OAKRIDGE RD STE A
MUSKEGON MI
49441-4097
US

IV. Provider business mailing address

865 OAKRIDGE RD STE A
MUSKEGON MI
49441-4097
US

V. Phone/Fax

Practice location:
  • Phone: 231-335-3116
  • Fax:
Mailing address:
  • Phone: 231-335-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KARLI BALDUS
Title or Position: CEO
Credential: LPC, LLP
Phone: 231-335-3116