Provider Demographics
NPI: | 1821638750 |
---|---|
Name: | HEALING TREE FAMILY COUNSELING INC |
Entity Type: | Organization |
Organization Name: | HEALING TREE FAMILY COUNSELING INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | THERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | WAINO |
Authorized Official - Last Name: | DAVIDSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 209-898-9859 |
Mailing Address - Street 1: | 2431 W MARCH LN STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | STOCKTON |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95207-8211 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 209-898-8399 |
Mailing Address - Fax: | 209-957-2587 |
Practice Address - Street 1: | 2431 W MARCH LN STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | STOCKTON |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95207-8211 |
Practice Address - Country: | US |
Practice Address - Phone: | 209-898-8399 |
Practice Address - Fax: | 209-957-2587 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-01-08 |
Last Update Date: | 2020-01-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty |