Healthcare Provider Details

I. General information

NPI: 1124130364
Provider Name (Legal Business Name): WHOLENESS HEALING CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 OLD FAIR RD
GRAND ISLAND NE
68803-5271
US

IV. Provider business mailing address

2608 OLD FAIR RD
GRAND ISLAND NE
68803-5271
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-5297
  • Fax: 308-382-5315
Mailing address:
  • Phone: 308-382-5297
  • Fax: 308-382-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JANE L WATSON
Title or Position: OWNER, DIRECTOR
Credential: LCSW
Phone: 308-382-5297