Provider Demographics
NPI:1669913471
Name:HEALTHY HEADS
Entity type:Organization
Organization Name:HEALTHY HEADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRTALA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-585-5423
Mailing Address - Street 1:1512 E INTERSTATE HIGHWAY 2 STE 107A
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6598
Mailing Address - Country:US
Mailing Address - Phone:956-585-5423
Mailing Address - Fax:
Practice Address - Street 1:1512 E INTERSTATE HIGHWAY 2 STE 107A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6598
Practice Address - Country:US
Practice Address - Phone:956-585-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty