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General NPI Number Information
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NPI Number | 1083594451
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Entity Type | Organization
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Legal Business Name | HEALING WATERS MARRIAGE AND FAMILY THERAPY INC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 16031 TUSCOLA RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1319
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Country | US
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Telephone | 661-209-3614
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Fax | 661-524-9950
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Provider Business Mailing Address
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Address Line | 16031 TUSCOLA RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1319
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Country | US
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Telephone | 661-209-3614
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Fax | 661-524-9950
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | NICOLE SEGROVES
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Credential |
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Telephone | 661-874-7851
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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