Provider Demographics
NPI:1124130364
Name:WHOLENESS HEALING CENTER PC
Entity type:Organization
Organization Name:WHOLENESS HEALING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:308-382-5297
Mailing Address - Street 1:2608 OLD FAIR RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5271
Mailing Address - Country:US
Mailing Address - Phone:308-382-5297
Mailing Address - Fax:308-382-5315
Practice Address - Street 1:2608 OLD FAIR RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5271
Practice Address - Country:US
Practice Address - Phone:308-382-5297
Practice Address - Fax:308-382-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025173200Medicaid
NE10025173100Medicaid
NE10025173100Medicaid