Healthcare Provider Details

I. General information

NPI: 1750040887
Provider Name (Legal Business Name): HEALING OASIS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6959 DEER BLUFF DR
DAYTON OH
45424-7040
US

IV. Provider business mailing address

PO BOX 24494
DAYTON OH
45424-0494
US

V. Phone/Fax

Practice location:
  • Phone: 937-518-0086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CAMILLA WILLIAMS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 267-879-0175