=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366337685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEPTHS OF HEALING THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 E CHOCOLATE AVE
-----------------------------------------------------
City | HERSHEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17033-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-565-9222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 580 MIDDLE ST APT 36
-----------------------------------------------------
City | EAST WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02189-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-565-9222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAYLA M SMITH
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 570-565-9222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------