Healthcare Provider Details

I. General information

NPI: 1700112810
Provider Name (Legal Business Name): HEALING SOULS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 EDGERTON ST
LITTLE CANADA MN
55117-1205
US

IV. Provider business mailing address

2903 EDGERTON ST
LITTLE CANADA MN
55117-1205
US

V. Phone/Fax

Practice location:
  • Phone: 651-490-1874
  • Fax: 651-490-1874
Mailing address:
  • Phone: 651-490-1874
  • Fax: 651-490-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number100670
License Number StateMN

VIII. Authorized Official

Name: MS. JEAN L FINLEY
Title or Position: OWNER/SOLE PROPRIETER
Credential: OTR/L
Phone: 651-490-1874