Provider Demographics
NPI:1245025279
Name:HEALING EPIPHANY INNOVATIVE SUPPORTIVE TREATMENT
Entity type:Organization
Organization Name:HEALING EPIPHANY INNOVATIVE SUPPORTIVE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKHART
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LICDC
Authorized Official - Phone:937-815-4904
Mailing Address - Street 1:304 RUPEL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1340
Practice Address - Country:US
Practice Address - Phone:937-815-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty