Provider Demographics
NPI:1275004608
Name:CENTER FOR DYNAMIC HEALING, INC
Entity Type:Organization
Organization Name:CENTER FOR DYNAMIC HEALING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:BARRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-828-9877
Mailing Address - Street 1:40946 US HIGHWAY 19 N # 421
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5446
Mailing Address - Country:US
Mailing Address - Phone:224-828-9877
Mailing Address - Fax:
Practice Address - Street 1:40946 US HIGHWAY 19 N # 421
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5446
Practice Address - Country:US
Practice Address - Phone:224-828-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No282J00000XHospitalsReligious Nonmedical Health Care InstitutionGroup - Single Specialty