Provider Demographics
NPI:1184404931
Name:HEALING SPOON LLC
Entity type:Organization
Organization Name:HEALING SPOON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:712-209-1703
Mailing Address - Street 1:7434 S LOUISE AVE # C203
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5955
Mailing Address - Country:US
Mailing Address - Phone:712-209-1703
Mailing Address - Fax:
Practice Address - Street 1:7434 S LOUISE AVE # C203
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5955
Practice Address - Country:US
Practice Address - Phone:712-209-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty