Provider Demographics
NPI:1255953923
Name:HEALING RELATIONSHIPS LLC
Entity type:Organization
Organization Name:HEALING RELATIONSHIPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:920-214-3733
Mailing Address - Street 1:150 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-1320
Mailing Address - Country:US
Mailing Address - Phone:920-214-3733
Mailing Address - Fax:920-267-4027
Practice Address - Street 1:150 MILLER ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-1320
Practice Address - Country:US
Practice Address - Phone:920-214-3733
Practice Address - Fax:920-267-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841733474Medicaid