Healthcare Provider Details

I. General information

NPI: 1184388308
Provider Name (Legal Business Name): THE HEALING EXPERIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8518 WINDY THICKET LN
CYPRESS TX
77433-1524
US

IV. Provider business mailing address

8518 WINDY THICKET LN
CYPRESS TX
77433-1524
US

V. Phone/Fax

Practice location:
  • Phone: 832-833-9209
  • Fax:
Mailing address:
  • Phone: 832-833-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: CORY BURGESS
Title or Position: OWNER
Credential: M.ED., BCBA, LBA
Phone: 832-418-4380