Provider Demographics
NPI:1215081310
Name:SPIRIT OF HEALING
Entity type:Organization
Organization Name:SPIRIT OF HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-863-1997
Mailing Address - Street 1:1818 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1849
Mailing Address - Country:US
Mailing Address - Phone:253-863-1997
Mailing Address - Fax:
Practice Address - Street 1:1818 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1849
Practice Address - Country:US
Practice Address - Phone:253-863-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006700101YM0800X
WARC00044737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty