Provider Demographics
NPI:1124400155
Name:HEALING STRIDES PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:HEALING STRIDES PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ELANA
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-845-8737
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:BLUE LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95525-1006
Mailing Address - Country:US
Mailing Address - Phone:707-845-8737
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1006
Practice Address - Street 2:
Practice Address - City:BLUE LAKE
Practice Address - State:CA
Practice Address - Zip Code:95525-1006
Practice Address - Country:US
Practice Address - Phone:707-845-8737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27263103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty