Healthcare Provider Details

I. General information

NPI: 1184257149
Provider Name (Legal Business Name): A HOLISTIC THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 FORSYTH BLVD FL 11
CLAYTON MO
63105-1878
US

IV. Provider business mailing address

PO BOX 6771
BRANDON FL
33508-6013
US

V. Phone/Fax

Practice location:
  • Phone: 813-530-5257
  • Fax:
Mailing address:
  • Phone: 773-203-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS ASHLEY A NAZON
Title or Position: OWNER
Credential: LCSW
Phone: 773-203-7263