Provider Demographics
NPI:1902046949
Name:THE HEALING PLACE
Entity Type:Organization
Organization Name:THE HEALING PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:307-265-3977
Mailing Address - Street 1:5725 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4382
Mailing Address - Country:US
Mailing Address - Phone:307-265-3977
Mailing Address - Fax:307-265-3038
Practice Address - Street 1:5725 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4382
Practice Address - Country:US
Practice Address - Phone:307-265-3977
Practice Address - Fax:307-265-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2017-11-16
Deactivation Date:2017-09-22
Deactivation Code:
Reactivation Date:2017-11-01
Provider Licenses
StateLicense IDTaxonomies
WYWY129101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty