Provider Demographics
NPI:1508215591
Name:HEALING PLACE THERAPY
Entity Type:Organization
Organization Name:HEALING PLACE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:IMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:765-744-9597
Mailing Address - Street 1:744 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-5236
Mailing Address - Country:US
Mailing Address - Phone:765-744-9597
Mailing Address - Fax:
Practice Address - Street 1:1811 BUNDY AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2973
Practice Address - Country:US
Practice Address - Phone:765-744-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001395A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000194594OtherANTHEM