Healthcare Provider Details

I. General information

NPI: 1033777370
Provider Name (Legal Business Name): HOLOS INTEGRATIVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 11/05/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SHELBY ST STE 212
INDIANAPOLIS IN
46203-1163
US

IV. Provider business mailing address

801 SHELBY ST STE 212
INDIANAPOLIS IN
46203-1163
US

V. Phone/Fax

Practice location:
  • Phone: 317-558-9410
  • Fax:
Mailing address:
  • Phone: 317-558-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH ELIZABETH STILZ
Title or Position: FOUNDER
Credential:
Phone: 317-558-9410