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General NPI Number Information
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NPI Number | 1083177877
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR SOMATIC HEALING
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 820 W 17TH ST STE 4
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3374
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Country | US
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Telephone | 812-322-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 1456 S STATE ROAD 446
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8800
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Country | US
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Telephone | 812-322-6714
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN SHEIKH
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Credential | LCSW
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Telephone | 812-322-6714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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