| Healing Alliance Llc | |
|
402 N Babcock St Melbourne FL 32935-7346 | |
| (321) 343-6821 | |
| Not Available |
| Full Name | Healing Alliance Llc |
|---|---|
| Speciality | Counselor |
| Location | 402 N Babcock St, Melbourne, Florida |
| Authorized Official Name and Position | Ingrid Pinto De Otazu (OWNER/LMHC) |
| Authorized Official Contact | 3213436821 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Alliance Llc 751 Ashbury Ave Melbourne FL 32940-6426 Ph: (321) 343-6821 | Healing Alliance Llc 402 N Babcock St Melbourne FL 32935-7346 Ph: (321) 343-6821 |
| NPI Number | 1053063735 |
|---|---|
| Provider Enumeration Date | 01/24/2022 |
| Last Update Date | 01/18/2024 |
| Certification Date | 01/18/2024 |
| Medicare PECOS PAC ID | 8426493099 |
|---|---|
| Medicare Enrollment ID | O20240305003351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053063735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ingrid Pinto De Otazu |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851752992 PECOS PAC ID: 9032554613 Enrollment ID: I20240305003744 |
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