Provider Demographics
NPI:1902101413
Name:HEALING JOURNEYS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:HEALING JOURNEYS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNASTASIA
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MANUTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:262-375-2506
Mailing Address - Street 1:W61N505 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1925
Mailing Address - Country:US
Mailing Address - Phone:262-375-2506
Mailing Address - Fax:262-375-2507
Practice Address - Street 1:W61N505 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1925
Practice Address - Country:US
Practice Address - Phone:262-375-2506
Practice Address - Fax:262-375-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty