=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982254504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING BRIDGES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2019
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8465 KEYSTONE XING STE 266
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-2592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-986-4956
-----------------------------------------------------
Fax | 317-452-8821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8465 KEYSTONE XING STE 266
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-2592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-986-4956
-----------------------------------------------------
Fax | 317-452-8821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHRYRN MILLER
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 317-319-4273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------