Healthcare Provider Details

I. General information

NPI: 1275220899
Provider Name (Legal Business Name): HOLISTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N FEDERAL HWY APT 215B
LIGHTHOUSE POINT FL
33064-6569
US

IV. Provider business mailing address

4502 N FEDERAL HWY APT 215B
LIGHTHOUSE POINT FL
33064-6569
US

V. Phone/Fax

Practice location:
  • Phone: 954-663-7657
  • Fax:
Mailing address:
  • Phone: 954-663-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LOUREN PRICE
Title or Position: OWNER/MANAGING MEMBER
Credential: LCSW, QS, MCAP
Phone: 954-663-7657