Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Clinical |
1041C0700X | 80 | Licensed Clinical Social Worker | |
Marriage & Family Therapist |
106H00000X | |||
Psychiatric/Mental Health |
363LP0808X | 50 | Nurse Practitioner |
| NPI Number | 1902308604 |
||||||||
| LBN Legal business name | HOLISTIC BEHAVIORAL HEALTH, LLC | ||||||||
| Authorized official | LA'SHONDRA DA CRUZ - (OWNER/CLINICIAN) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 03/08/2018 | ||||||||
| Last updated | 10/29/2022 - About 4 years ago | ||||||||
| Identifiers |
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