Provider Demographics
NPI:1316256662
Name:HAFTEL HEALING ARTS LLC
Entity type:Organization
Organization Name:HAFTEL HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAFTEL
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LMHC
Authorized Official - Phone:904-206-0641
Mailing Address - Street 1:97052 KATFISH LN
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2477
Mailing Address - Country:US
Mailing Address - Phone:904-261-8744
Mailing Address - Fax:904-491-3337
Practice Address - Street 1:1885 S 14TH ST
Practice Address - Street 2:#5
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3033
Practice Address - Country:US
Practice Address - Phone:904-206-0641
Practice Address - Fax:904-491-3337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION E HAFTEL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty