Provider Demographics
NPI:1679594535
Name:H B THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:H B THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BLACKSTUN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, MBA
Authorized Official - Phone:573-289-8144
Mailing Address - Street 1:1810 CALEDON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8458
Mailing Address - Country:US
Mailing Address - Phone:573-289-8144
Mailing Address - Fax:
Practice Address - Street 1:2012 CHERRY HILL DR STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5882
Practice Address - Country:US
Practice Address - Phone:573-289-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010245821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty