Provider Demographics
NPI:1750742144
Name:THE HEALING PRACTICE, LLC
Entity type:Organization
Organization Name:THE HEALING PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,LAC
Authorized Official - Phone:203-550-2755
Mailing Address - Street 1:555 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4749
Mailing Address - Country:US
Mailing Address - Phone:203-550-2755
Mailing Address - Fax:877-635-5324
Practice Address - Street 1:555 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4749
Practice Address - Country:US
Practice Address - Phone:203-550-2755
Practice Address - Fax:877-635-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty