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General NPI Number Information
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NPI Number | 1407549041
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Entity Type | Organization
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Legal Business Name | HEALING HUB LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 8677 N WAYNE DR STE B
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City | HAYDEN
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State | ID
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Zip | 83835-5190
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Country | US
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Telephone | 208-691-0691
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Fax |
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Provider Business Mailing Address
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Address Line | 2680 E HAYDEN VIEW DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-7038
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Country | US
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Telephone | 208-691-0691
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ASHTON UNDERDAHL
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Credential |
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Telephone | 208-691-0691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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