Provider Demographics
NPI:1003503897
Name:MIDE INTEGRATIVE THERAPIES
Entity Type:Organization
Organization Name:MIDE INTEGRATIVE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:707-337-6721
Mailing Address - Street 1:3408 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-1209
Mailing Address - Country:US
Mailing Address - Phone:707-337-6721
Mailing Address - Fax:
Practice Address - Street 1:1516 W RIVERSIDE AVE STE 208
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1241
Practice Address - Country:US
Practice Address - Phone:707-337-6721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)