Healthcare Provider Details

I. General information

NPI: 1649870783
Provider Name (Legal Business Name): HOLISTIC HEALTH AND PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 HOLLOW TREE DR STE 111
ARLINGTON TX
76018-1288
US

IV. Provider business mailing address

4601 HOLLOW TREE DR STE 111
ARLINGTON TX
76018-1288
US

V. Phone/Fax

Practice location:
  • Phone: 817-546-8000
  • Fax: 817-345-0465
Mailing address:
  • Phone: 817-546-8000
  • Fax: 817-345-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PETER FORMUSOH
Title or Position: OWNER OF ENTITY
Credential: APRN
Phone: 817-546-8000