Provider Demographics
NPI:1063139749
Name:HEALING HOUSE THERAPY LLC
Entity type:Organization
Organization Name:HEALING HOUSE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NBCC
Authorized Official - Phone:616-813-3626
Mailing Address - Street 1:48051 COUNTY ROAD 673
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-9674
Mailing Address - Country:US
Mailing Address - Phone:616-813-3626
Mailing Address - Fax:
Practice Address - Street 1:50560 COUNTY ROAD 652
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071
Practice Address - Country:US
Practice Address - Phone:269-409-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty