Provider Demographics
NPI:1053063735
Name:HEALING ALLIANCE LLC
Entity Type:Organization
Organization Name:HEALING ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMHC
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:PINTO DE OTAZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-343-6821
Mailing Address - Street 1:751 ASHBURY AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6426
Mailing Address - Country:US
Mailing Address - Phone:321-343-6821
Mailing Address - Fax:
Practice Address - Street 1:402 N BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7346
Practice Address - Country:US
Practice Address - Phone:321-343-6821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty