Provider Demographics
NPI: | 1679398671 |
---|---|
Name: | SOUND MIND WHOLE HEART THERAPY LLC |
Entity type: | Organization |
Organization Name: | SOUND MIND WHOLE HEART THERAPY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LEAH |
Authorized Official - Middle Name: | ANNE |
Authorized Official - Last Name: | RICHTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 501-310-4233 |
Mailing Address - Street 1: | 2112 W HUNTSVILLE AVE STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGDALE |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72762-2600 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-310-4233 |
Mailing Address - Fax: | 501-492-6439 |
Practice Address - Street 1: | 2112 W HUNTSVILLE AVE STE B |
Practice Address - Street 2: | |
Practice Address - City: | SPRINGDALE |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72762-2600 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-310-4233 |
Practice Address - Fax: | 501-492-6439 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-11-15 |
Last Update Date: | 2024-11-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |