Healthcare Provider Details

I. General information

NPI: 1851104194
Provider Name (Legal Business Name): HOLISTIC PSYCHEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 BLUE HILL TER
NORTHBROOK IL
60062-4406
US

IV. Provider business mailing address

1224 BLUE HILL TER
NORTHBROOK IL
60062-4406
US

V. Phone/Fax

Practice location:
  • Phone: 847-864-4961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CLEOPATRA SMYRNIOTES
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 847-763-7210