Provider Demographics
NPI:1003172909
Name:HORIZONS COMMUNITY CHURCH
Entity Type:Organization
Organization Name:HORIZONS COMMUNITY CHURCH
Other - Org Name:THE HEALING PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LP
Authorized Official - Phone:763-413-8142
Mailing Address - Street 1:1503 157TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-5658
Mailing Address - Country:US
Mailing Address - Phone:763-413-8142
Mailing Address - Fax:763-445-2015
Practice Address - Street 1:1503 157TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-5658
Practice Address - Country:US
Practice Address - Phone:763-413-8142
Practice Address - Fax:763-445-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health