Provider Demographics
NPI:1285047530
Name:HOPE IN HEALING
Entity type:Organization
Organization Name:HOPE IN HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/MHSP
Authorized Official - Phone:615-964-7113
Mailing Address - Street 1:607 W DUE WEST AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4420
Mailing Address - Country:US
Mailing Address - Phone:615-964-7113
Mailing Address - Fax:888-872-5109
Practice Address - Street 1:607 W DUE WEST AVE STE 106
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4420
Practice Address - Country:US
Practice Address - Phone:615-964-7113
Practice Address - Fax:615-928-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005513Medicaid