Provider Demographics
NPI:1619529385
Name:EARTH ANGELS HEALING CLINIC LLC
Entity Type:Organization
Organization Name:EARTH ANGELS HEALING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:985-259-2811
Mailing Address - Street 1:3408 PONTCHARTRAIN DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4830
Mailing Address - Country:US
Mailing Address - Phone:504-291-6704
Mailing Address - Fax:
Practice Address - Street 1:3408 PONTCHARTRAIN DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4830
Practice Address - Country:US
Practice Address - Phone:504-291-6704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty