Provider Demographics
NPI:1407749385
Name:THE OPEN HEART THERAPIST PLLC
Entity type:Organization
Organization Name:THE OPEN HEART THERAPIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:G N
Authorized Official - Last Name:BOULET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-223-5521
Mailing Address - Street 1:2709 PINEDALE RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2018
Mailing Address - Country:US
Mailing Address - Phone:336-223-5521
Mailing Address - Fax:336-288-3177
Practice Address - Street 1:2709 PINEDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2018
Practice Address - Country:US
Practice Address - Phone:336-223-5521
Practice Address - Fax:336-288-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health