Healthcare Provider Details

I. General information

NPI: 1902306269
Provider Name (Legal Business Name): HOLOS CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W CENTER ST
FAYETTEVILLE AR
72701-5934
US

IV. Provider business mailing address

230 W CENTER ST
FAYETTEVILLE AR
72701-5934
US

V. Phone/Fax

Practice location:
  • Phone: 479-688-3688
  • Fax: 866-649-6788
Mailing address:
  • Phone: 479-688-3688
  • Fax: 866-649-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberM1303002
License Number StateAR

VIII. Authorized Official

Name: ANGELA M LEEK
Title or Position: OWNER
Credential: MA, LMFT, LPC
Phone: 479-668-3688