Healthcare Provider Details

I. General information

NPI: 1477281624
Provider Name (Legal Business Name): HEALING WITH GRACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-4835
US

IV. Provider business mailing address

2637 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-4835
US

V. Phone/Fax

Practice location:
  • Phone: 702-716-0908
  • Fax:
Mailing address:
  • Phone: 702-772-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KANA NOOTENBOOM
Title or Position: CLINICAL DIRECTOR
Credential: MFT
Phone: 702-772-9552