Basic Information
| Provider Information | |||||||||
| NPI: | 1124660105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING MINDS BODIES AND SOULS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11742 E ASBURY PL | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800141104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065458910 | ||||||||
| FaxNumber: | 7196257610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1181 E BRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065458910 | ||||||||
| FaxNumber: | 7196257610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2019 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | PERKINS | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4065458910 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.