Provider Demographics
NPI:1760064489
Name:GUIDED HEALING
Entity Type:Organization
Organization Name:GUIDED HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:618-917-4207
Mailing Address - Street 1:343 MOULTRIE LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7174
Mailing Address - Country:US
Mailing Address - Phone:618-917-4207
Mailing Address - Fax:
Practice Address - Street 1:6209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-2015
Practice Address - Country:US
Practice Address - Phone:618-917-4207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty