Basic Information
| Provider Information | |||||||||
| NPI: | 1124400155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING STRIDES PSYCHOTHERAPY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1006 | ||||||||
| Address2: | |||||||||
| City: | BLUE LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955251006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078458737 | ||||||||
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| Address1: | PO BOX 1006 | ||||||||
| Address2: | |||||||||
| City: | BLUE LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955251006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078458737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2015 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | JENNINGS | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | ELANA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7078458737 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | PSY27263 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.