Basic Information
| Provider Information | |||||||||
| NPI: | 1811351935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING INTERNAL MINISTRIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 FREEMAN TER | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011042551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134333280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 CENTER ST | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010132680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132733736 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 04/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | JAIME | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4134333280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 8229 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.