Healthcare Provider Details

I. General information

NPI: 1215746052
Provider Name (Legal Business Name): HOLISTIC BEHAVIORAL & PSYCHOLOGICAL SERVICES, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10565 N 114TH ST STE 107
SCOTTSDALE AZ
85259-4942
US

IV. Provider business mailing address

10565 N 114TH ST STE 107
SCOTTSDALE AZ
85259-4942
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-9596
  • Fax: 480-716-4020
Mailing address:
  • Phone: 480-256-9596
  • Fax: 480-716-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. ELENA MARIE RIVERA
Title or Position: CEO
Credential: PSYD.
Phone: 602-292-4680