Provider Demographics
NPI:1790541977
Name:HEALING HEARTS THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:HEALING HEARTS THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:909-446-2459
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-0438
Mailing Address - Country:US
Mailing Address - Phone:909-446-2459
Mailing Address - Fax:
Practice Address - Street 1:541 SUSQUEHANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2784
Practice Address - Country:US
Practice Address - Phone:909-446-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty