Provider Demographics
NPI:1265210439
Name:THE HEALING VILLAGE
Entity type:Organization
Organization Name:THE HEALING VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LLP
Authorized Official - Phone:231-335-3116
Mailing Address - Street 1:865 OAKRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4097
Mailing Address - Country:US
Mailing Address - Phone:231-335-3116
Mailing Address - Fax:
Practice Address - Street 1:865 OAKRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4097
Practice Address - Country:US
Practice Address - Phone:231-335-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty