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General NPI Number Information
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NPI Number | 1104698083
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Entity Type | Organization
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Legal Business Name | HEALING TIDES COUNSELING LLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 215 FIDALGO AVE
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City | KENAI
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State | AK
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Zip | 99611-7776
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Country | US
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Telephone | 907-744-7969
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Fax | 907-206-7194
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Provider Business Mailing Address
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Address Line | 1515 WEDGEWOOD DR
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City | KENAI
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State | AK
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Zip | 99611-6636
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Country | US
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Telephone | 907-744-7969
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Fax | 907-206-7194
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Authorized Official
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Title or Position | MANAGER
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Name | MICHA SAVAGE
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Credential |
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Telephone | 208-724-7237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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