Provider Demographics
NPI:1477646909
Name:THE HEALING PLACE
Entity Type:Organization
Organization Name:THE HEALING PLACE
Other - Org Name:THE HEALING PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:713-895-0062
Mailing Address - Street 1:5450 NW CENTRAL DR. SUITE 109
Mailing Address - Street 2:SAME AS ABOVE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092
Mailing Address - Country:US
Mailing Address - Phone:713-895-0062
Mailing Address - Fax:281-897-0413
Practice Address - Street 1:5450 NW CENTRAL DR. SUITE 109
Practice Address - Street 2:SAME AS ABOVE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092
Practice Address - Country:US
Practice Address - Phone:713-895-0062
Practice Address - Fax:281-897-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18918101Y00000X
TX17843101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty