Provider Demographics
NPI:1104698083
Name:HEALING TIDES COUNSELING LLC
Entity type:Organization
Organization Name:HEALING TIDES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-724-7237
Mailing Address - Street 1:1515 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6636
Mailing Address - Country:US
Mailing Address - Phone:907-744-7969
Mailing Address - Fax:907-206-7194
Practice Address - Street 1:215 FIDALGO AVE
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7776
Practice Address - Country:US
Practice Address - Phone:907-744-7969
Practice Address - Fax:907-206-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty