Provider Demographics
NPI:1437246675
Name:HEALING THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:HEALING THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:ZENZ-OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-427-2590
Mailing Address - Street 1:6893 139TH LN NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4814
Mailing Address - Country:US
Mailing Address - Phone:763-427-2590
Mailing Address - Fax:763-427-2579
Practice Address - Street 1:6893 139TH LN NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4814
Practice Address - Country:US
Practice Address - Phone:763-427-2590
Practice Address - Fax:763-427-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN652640300Medicaid
MN800001429Medicare ID - Type Unspecified