Healthcare Provider Details

I. General information

NPI: 1912818956
Provider Name (Legal Business Name): MY PAIN HIS PURPOSE MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 EXPRESS DR
JACKSON TN
38305-6059
US

IV. Provider business mailing address

20 WHISPER CREEK DR
JACKSON TN
38305-6106
US

V. Phone/Fax

Practice location:
  • Phone: 970-430-6552
  • Fax:
Mailing address:
  • Phone: 970-430-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BROOKE
Title or Position: FOUNDER
Credential: LPC
Phone: 719-480-1525