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General NPI Number Information
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NPI Number | 1124400155
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Entity Type | Organization
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Legal Business Name | HEALING STRIDES PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | PO BOX 1006
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City | BLUE LAKE
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State | CA
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Zip | 95525-1006
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Country | US
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Telephone | 707-845-8737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1006
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City | BLUE LAKE
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State | CA
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Zip | 95525-1006
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Country | US
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Telephone | 707-845-8737
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRI ELANA JENNINGS
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Credential | PH.D.
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Telephone | 707-845-8737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY27263
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License Number State | CA
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