Provider Demographics
NPI:1083177877
Name:THE CENTER FOR SOMATIC HEALING
Entity Type:Organization
Organization Name:THE CENTER FOR SOMATIC HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-322-6714
Mailing Address - Street 1:1456 S STATE ROAD 446
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8800
Mailing Address - Country:US
Mailing Address - Phone:812-322-6714
Mailing Address - Fax:
Practice Address - Street 1:820 W 17TH ST STE 4
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3374
Practice Address - Country:US
Practice Address - Phone:812-322-6714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty