Provider Demographics
NPI:1710750773
Name:LIZ HEALING HEARTS BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:LIZ HEALING HEARTS BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOULLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-372-4493
Mailing Address - Street 1:5180 NW 7TH ST APT 606
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5180 NW 7TH ST APT 606
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3348
Practice Address - Country:US
Practice Address - Phone:786-372-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty