Provider Demographics
NPI:1710943089
Name:A TIME FOR HEALING, LLC
Entity Type:Organization
Organization Name:A TIME FOR HEALING, LLC
Other - Org Name:A TIME FOR HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-457-5163
Mailing Address - Street 1:7400 METRO BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2356
Mailing Address - Country:US
Mailing Address - Phone:952-388-8990
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 335
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2356
Practice Address - Country:US
Practice Address - Phone:952-388-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN874127100Medicaid