Basic Information
| Provider Information | |||||||||
| NPI: | 1972253805 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALING CONCEPTS BY MARY RUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18530 156TH AVE NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254895900 | ||||||||
| FaxNumber: | 4254895920 | ||||||||
| Practice Location | |||||||||
| Address1: | 18530 156TH AVE NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254895900 | ||||||||
| FaxNumber: | 4254895920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2022 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | WHITEHEAD | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | NATUROPATHIC DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 4254895900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | ND | ||||||||
| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 171100000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist | 225700000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 261QI0500X | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 175F00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Naturopath |
ID Information
| ID | Type | State | Issuer | Description | 2096240 | 05 | WA | MEDICAID |