Provider Demographics
NPI:1659199339
Name:TREE OF LIFE HEALING, INC.
Entity type:Organization
Organization Name:TREE OF LIFE HEALING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:818-568-6982
Mailing Address - Street 1:491 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3128
Mailing Address - Country:US
Mailing Address - Phone:818-568-6982
Mailing Address - Fax:
Practice Address - Street 1:491 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3128
Practice Address - Country:US
Practice Address - Phone:818-568-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty