Provider Demographics
NPI:1871014993
Name:HEALING PLACE
Entity Type:Organization
Organization Name:HEALING PLACE
Other - Org Name:THE HEALING PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-412-2729
Mailing Address - Street 1:614 WILLIAM MORTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2129
Mailing Address - Country:US
Mailing Address - Phone:713-412-2729
Mailing Address - Fax:
Practice Address - Street 1:2060 NORTH LOOP W STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8146
Practice Address - Country:US
Practice Address - Phone:713-412-2729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003GZAOtherBLUE CROSS BLUE SHIELD OF TEXAS
13998156OtherCAQH