Provider Demographics
NPI:1982221842
Name:GOD HEALER OF HEARTS COUNSELING CENTER PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GOD HEALER OF HEARTS COUNSELING CENTER PROFESSIONAL CORPORATION
Other - Org Name:GOD HEALER OF HEARTS COUNSELING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:469-778-0022
Mailing Address - Street 1:18601 LYNDON B JOHNSON FWY STE 509
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6434
Mailing Address - Country:US
Mailing Address - Phone:469-778-0022
Mailing Address - Fax:833-945-1991
Practice Address - Street 1:18601 LYNDON B JOHNSON FWY STE 509
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6434
Practice Address - Country:US
Practice Address - Phone:469-778-0022
Practice Address - Fax:833-945-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health