|Taxonomy Code||Specialty Code||Provider Type|
|1041C0700X||80||Licensed Clinical Social Worker|
|364SP0808X||89||Certified Clinical Nurse Specialist|
|LBN Legal business name||ESSENTIAL HEALING IOP, INC|
|Authorized official||STEVANIE SMITH - (PROGRAM DIRECTOR/THERAPIST)|
|Organization subpart 1||No|
|Last updated||09/28/2015 - More than a year ago|
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ESSENTIAL HEALING IOP, INC
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