Provider Demographics
NPI:1225335557
Name:HALLERS HEALING MINDS INC
Entity Type:Organization
Organization Name:HALLERS HEALING MINDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ASCW
Authorized Official - Phone:989-239-8628
Mailing Address - Street 1:3070 KABOBEL DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2516
Mailing Address - Country:US
Mailing Address - Phone:989-791-4191
Mailing Address - Fax:989-791-4191
Practice Address - Street 1:3070 KABOBEL DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2516
Practice Address - Country:US
Practice Address - Phone:989-791-4191
Practice Address - Fax:989-791-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010650921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008949790OtherBLUE CROSS
MI112622OtherVALUE OPTIONS
MI112622OtherVALUE OPTIONS