Provider Demographics
NPI:1053930412
Name:HEALING ARTS NORTH PLLC
Entity type:Organization
Organization Name:HEALING ARTS NORTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:LOCKEY
Authorized Official - Last Name:SARRAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:231-445-9010
Mailing Address - Street 1:520 N MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1171
Mailing Address - Country:US
Mailing Address - Phone:989-372-1493
Mailing Address - Fax:
Practice Address - Street 1:520 N MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1171
Practice Address - Country:US
Practice Address - Phone:989-372-1493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639664741OtherINDIVIDUAL NPI
MI6801103192OtherPROFESSIONAL LIMITED LICENSE
MI1639664741Medicaid