Healthcare Provider Details

I. General information

NPI: 1770284655
Provider Name (Legal Business Name): HOLISTIC MINDSET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE RAMON LUIS RIVERA EDIFICIO GALLARDO OFIC 204
BAYAMON PR
00961
US

IV. Provider business mailing address

HH30 CALLE SANDY URB. BAYAMON GARDENS
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 939-599-2197
  • Fax:
Mailing address:
  • Phone: 787-628-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: YESENIA PACHECO LLANOS
Title or Position: AGENTE RESIDENTE
Credential:
Phone: 787-628-4616