Healthcare Provider Details

I. General information

NPI: 1467947697
Provider Name (Legal Business Name): HOLISTIC INTEGRATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 01/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 8TH AVE
GAINESVILLE FL
32601-5059
US

IV. Provider business mailing address

900 NW 8TH AVE STE H
GAINESVILLE FL
32601-5059
US

V. Phone/Fax

Practice location:
  • Phone: 813-534-0270
  • Fax:
Mailing address:
  • Phone: 813-534-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW14469
License Number StateFL

VIII. Authorized Official

Name: JULIA JACKSON
Title or Position: OWNER
Credential:
Phone: 561-609-8660