Provider Demographics
NPI:1679257729
Name:HEAL THE PAST LLC
Entity type:Organization
Organization Name:HEAL THE PAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GOLNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLNARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, LMFT
Authorized Official - Phone:619-306-6979
Mailing Address - Street 1:9108 MERIWETHER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9108 MERIWETHER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6416
Practice Address - Country:US
Practice Address - Phone:619-306-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty