Healthcare Provider Details

I. General information

NPI: 1104509140
Provider Name (Legal Business Name): HOLISTIC WELLNESS & PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 ESTATE THOMAS
ST THOMAS VI
00802-2611
US

IV. Provider business mailing address

42 7TH AVE SW STE 100
CEDAR RAPIDS IA
52404-2185
US

V. Phone/Fax

Practice location:
  • Phone: 340-224-9658
  • Fax: 855-300-4759
Mailing address:
  • Phone: 319-800-2125
  • Fax: 855-300-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE MAY MCCORMICK
Title or Position: OWNER
Credential: MD
Phone: 319-471-1749