Provider Demographics
NPI:1003124272
Name:HEALING SPIRIT THERAPIES, LLC
Entity Type:Organization
Organization Name:HEALING SPIRIT THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-200-8472
Mailing Address - Street 1:221 N EAST AVE
Mailing Address - Street 2:#201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5226
Mailing Address - Country:US
Mailing Address - Phone:479-200-8472
Mailing Address - Fax:479-442-2881
Practice Address - Street 1:221 N EAST AVE
Practice Address - Street 2:#201
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5226
Practice Address - Country:US
Practice Address - Phone:479-200-8472
Practice Address - Fax:479-442-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1729-C261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)