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General NPI Number Information
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NPI Number | 1124130364
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Entity Type | Organization
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Legal Business Name | WHOLENESS HEALING CENTER PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 2608 OLD FAIR RD
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City | GRAND ISLAND
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State | NE
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Zip | 68803-5271
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Country | US
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Telephone | 308-382-5297
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Fax | 308-382-5315
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Provider Business Mailing Address
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Address Line | 2608 OLD FAIR RD
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City | GRAND ISLAND
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State | NE
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Zip | 68803-5271
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Country | US
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Telephone | 308-382-5297
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Fax | 308-382-5315
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | MS. JANE L WATSON
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Credential | LCSW
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Telephone | 308-382-5297
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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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