MEDICARE: HOLISTIC HEALTH AND PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1649870783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALTH AND PSYCHIATRY

Provider Business Mailing Address
First Line	:	4601 HOLLOW TREE DR STE 111
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1288
Country	:	US
Telephone Number	:	817-546-8000
Fax Number	:	817-345-0465

Provider Business Practice Location Address
First Line	:	4601 HOLLOW TREE DR STE 111
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1288
Country	:	US
Telephone Number	:	817-546-8000
Fax Number	:	817-345-0465

Authorized Official
Title or Position	:	OWNER OF ENTITY
Name	:	PETER FORMUSOH
Credential	:	APRN
Telephone Number	:	817-546-8000

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	12/12/2025

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