Provider Demographics
NPI:1104141563
Name:HEALING THERAPEUTICS, LLC
Entity type:Organization
Organization Name:HEALING THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACCS, MACCS
Authorized Official - Phone:480-686-1818
Mailing Address - Street 1:12133 N 127TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3425
Mailing Address - Country:US
Mailing Address - Phone:480-686-1818
Mailing Address - Fax:480-264-7481
Practice Address - Street 1:21803 N SCOTTSDALE RD
Practice Address - Street 2:#110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7438
Practice Address - Country:US
Practice Address - Phone:480-585-4673
Practice Address - Fax:480-264-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35043332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ088377Medicaid
AZ088377Medicaid