Provider Demographics
NPI:1093295859
Name:HEALING HEARTS THERAPY, LLC
Entity Type:Organization
Organization Name:HEALING HEARTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:MORIAH
Authorized Official - Last Name:NELSON-EGEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-570-1317
Mailing Address - Street 1:511 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5907
Mailing Address - Country:US
Mailing Address - Phone:701-570-1317
Mailing Address - Fax:
Practice Address - Street 1:511 2ND ST W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5907
Practice Address - Country:US
Practice Address - Phone:701-570-1317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4969261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)