Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center | |
Adult Mental Health |
261QM0850X | |||
Substance Abuse Treatment, Children |
3245S0500X |
| NPI Number | 1033750526 |
| LBN Legal business name | HEALING WATERS/LIFE CHANGERS LLC |
| Authorized official | JACQUELINE PHILLIPS - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/05/2019 |
| Last updated | 10/05/2019 - About 7 years ago |
| Identifiers | n/a |
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