Provider Demographics
NPI:1053851196
Name:CARING HEARTS THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:CARING HEARTS THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:KONRAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-504-5782
Mailing Address - Street 1:15204 CARTER LOOP SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8573
Mailing Address - Country:US
Mailing Address - Phone:805-504-5782
Mailing Address - Fax:
Practice Address - Street 1:15204 CARTER LOOP SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8573
Practice Address - Country:US
Practice Address - Phone:805-504-5782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11314334103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty