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General NPI Number Information
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NPI Number | 1568827616
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Entity Type | Organization
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Legal Business Name | WOUNDED HEALERS ENERGY CENTER, LLC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 187 E STATE ST STE C
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City | ATHENS
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State | OH
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Zip | 45701-1764
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Country | US
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Telephone | 740-818-8273
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Fax |
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Provider Business Mailing Address
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Address Line | 11 E WASHINGTON ST STE C
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City | ATHENS
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State | OH
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Zip | 45701-1569
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Country | US
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Telephone | 740-818-8273
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PAIGE STRETTON
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Credential |
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Telephone | 740-818-8273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E1665
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License Number State | OH
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