Provider Demographics
NPI:1154762490
Name:PSYCHOLOGICAL WELLNESS AND HEALING
Entity type:Organization
Organization Name:PSYCHOLOGICAL WELLNESS AND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-873-8060
Mailing Address - Street 1:PO BOX 19163
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49019-0163
Mailing Address - Country:US
Mailing Address - Phone:269-873-8060
Mailing Address - Fax:
Practice Address - Street 1:3503 GREENLEAF BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2580
Practice Address - Country:US
Practice Address - Phone:269-873-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty