Provider Demographics
NPI:1376310920
Name:SIMPLY HEALING TRAUMA INC
Entity Type:Organization
Organization Name:SIMPLY HEALING TRAUMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:K
Authorized Official - Last Name:RYZUK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, EDS, LPC, ACS
Authorized Official - Phone:973-476-1329
Mailing Address - Street 1:18 MACCULLOCH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-9448
Mailing Address - Country:US
Mailing Address - Phone:973-476-1329
Mailing Address - Fax:
Practice Address - Street 1:18 MACCULLOCH AVE STE 2
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-9448
Practice Address - Country:US
Practice Address - Phone:973-476-1329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health