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General NPI Number Information
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NPI Number | 1952806556
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Entity Type | Organization
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Legal Business Name | SACRED HEALING THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 6144 DEVON ST
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City | PORTAGE
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State | MI
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Zip | 49024-2648
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Country | US
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Telephone | 734-709-2096
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | MASON
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State | MI
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Zip | 48854-0010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MARY BETH HOUPT
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Credential |
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Telephone | 517-676-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801075829
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License Number State | MI
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Taxonomy #2
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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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