Healthcare Provider Details

I. General information

NPI: 1033501523
Provider Name (Legal Business Name): HEALING ROOM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 CATO AVE SUITE 101
STATE COLLEGE PA
16801-2765
US

IV. Provider business mailing address

2023 CATO AVE SUITE 101
STATE COLLEGE PA
16801-2765
US

V. Phone/Fax

Practice location:
  • Phone: 814-599-4124
  • Fax:
Mailing address:
  • Phone: 814-599-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006863
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017193
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KATHERINE GATES-MOORE
Title or Position: CO-OWNER
Credential: LCSW
Phone: 814-599-4124