Provider Demographics
NPI:1255120077
Name:HEALING ON TAMPA
Entity type:Organization
Organization Name:HEALING ON TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CELEINY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-728-9438
Mailing Address - Street 1:610 E ZACK ST STE 110-2322
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3972
Mailing Address - Country:US
Mailing Address - Phone:813-728-9438
Mailing Address - Fax:
Practice Address - Street 1:3359 W HIDDEN HAVEN CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6635
Practice Address - Country:US
Practice Address - Phone:813-728-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health