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General NPI Number Information
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NPI Number | 1437959376
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Entity Type | Organization
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Legal Business Name | NEUTRAL GROUND HEALING COLLECTIVE, LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 500 N 13TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3955
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Country | US
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Telephone | 267-636-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 32 W ALLENS LN
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1637
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Country | US
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Telephone | 267-574-6061
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KELLY JUDE
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Credential | LCSW
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Telephone | 267-291-4385
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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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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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