Healthcare Provider Details

I. General information

NPI: 1306414107
Provider Name (Legal Business Name): HOLISTIC THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NAPA VALLEY DR STE 10
LITTLE ROCK AR
72212-3913
US

IV. Provider business mailing address

1060 HOGAN LN UNIT 10856
CONWAY AR
72034-4532
US

V. Phone/Fax

Practice location:
  • Phone: 501-651-0647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAVANNA SCOTT
Title or Position: OWNER AND THERAPIST
Credential:
Phone: 501-651-0647