Healthcare Provider Details

I. General information

NPI: 1093524480
Provider Name (Legal Business Name): HOLISTIC PSYCHOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 4TH ST STE 209
SANTA ROSA CA
95404-4457
US

IV. Provider business mailing address

613 4TH ST STE 209
SANTA ROSA CA
95404-4457
US

V. Phone/Fax

Practice location:
  • Phone: 707-623-0500
  • Fax:
Mailing address:
  • Phone: 707-623-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARTIN LAJOIE
Title or Position: CEO / PSYCHOLOGIST
Credential: PSYD
Phone: 707-623-0500