Provider Demographics
NPI:1003159112
Name:HEALING HOUSE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:HEALING HOUSE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEABOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-996-3547
Mailing Address - Street 1:8831 S REDWOOD RD STE C1
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9284
Mailing Address - Country:US
Mailing Address - Phone:801-996-3547
Mailing Address - Fax:801-996-3560
Practice Address - Street 1:8831 S REDWOOD RD STE C1
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9284
Practice Address - Country:US
Practice Address - Phone:801-996-3547
Practice Address - Fax:801-996-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20956251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health