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General NPI Number Information
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NPI Number | 1518491471
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Entity Type | Organization
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Legal Business Name | THE HEALTHY HIVE, LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 205 E COMMERCE ST SUITE 209
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City | JACKSONVILLE
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State | TX
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Zip | 75766-4970
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Country | US
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Telephone | 903-316-6386
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Fax |
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Provider Business Mailing Address
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Address Line | 771 AN COUNTY ROAD 142
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City | PALESTINE
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State | TX
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Zip | 75801-6313
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Country | US
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Telephone | 903-316-6386
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/ OWNER
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Name | NIKKI BYBEE GOODALE
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Credential | OTR,CLT
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Telephone | 903-316-6386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 114230
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License Number State | TX
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