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General NPI Number Information
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NPI Number | 1992574578
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Entity Type | Organization
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Legal Business Name | OMNIHEALING THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 12/25/2023
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 5901 BROOKLYN BLVD STE 201
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2533
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Country | US
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Telephone | 651-337-9047
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Fax | 763-657-1689
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Provider Business Mailing Address
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Address Line | 5901 BROOKLYN BLVD STE 201
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2533
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Country | US
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Telephone | 651-337-9047
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Fax | 763-657-1689
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KIARA OWENS
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Credential | MA, LMFT
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Telephone | 763-732-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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