Provider Demographics
NPI:1235830878
Name:HEALED AND WHOLE THERAPY, LLC
Entity Type:Organization
Organization Name:HEALED AND WHOLE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:LYNNZEY
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-504-5921
Mailing Address - Street 1:335 EDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1224
Mailing Address - Country:US
Mailing Address - Phone:256-504-5921
Mailing Address - Fax:
Practice Address - Street 1:6 OFFICE PARK CIR STE 304
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2786
Practice Address - Country:US
Practice Address - Phone:205-883-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty