Provider Demographics
NPI:1003387705
Name:HEALTHY HEALING, LLC
Entity Type:Organization
Organization Name:HEALTHY HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISMYTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-830-4849
Mailing Address - Street 1:280 DOBBS FERRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1908
Mailing Address - Country:US
Mailing Address - Phone:914-830-4849
Mailing Address - Fax:914-885-1175
Practice Address - Street 1:280 DOBBS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1908
Practice Address - Country:US
Practice Address - Phone:914-830-4849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1366851776Medicaid