Healthcare Provider Details

I. General information

NPI: 1225921265
Provider Name (Legal Business Name): HOLISTICALLY YOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E BELTLINE AVE NE STE 106-1409
GRAND RAPIDS MI
49525-7045
US

IV. Provider business mailing address

1971 E BELTLINE AVE NE STE 1061409
GRAND RAPIDS MI
49525-7045
US

V. Phone/Fax

Practice location:
  • Phone: 980-317-0318
  • Fax:
Mailing address:
  • Phone: 980-317-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TAMARIS GALLOWAY
Title or Position: CEO
Credential:
Phone: 980-483-9262