Provider Demographics
NPI:1750013694
Name:HEALING TIDES THERAPY, LLC
Entity Type:Organization
Organization Name:HEALING TIDES THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLENKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-564-5447
Mailing Address - Street 1:370 SELBY AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1884
Mailing Address - Country:US
Mailing Address - Phone:612-723-1610
Mailing Address - Fax:
Practice Address - Street 1:370 SELBY AVE STE 322
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1884
Practice Address - Country:US
Practice Address - Phone:612-723-1610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health