Healthcare Provider Details

I. General information

NPI: 1205512746
Provider Name (Legal Business Name): HOLISTIC BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8777 W FOREST HOME AVE
GREENFIELD WI
53228-3421
US

IV. Provider business mailing address

8777 W FOREST HOME AVE
GREENFIELD WI
53228-3421
US

V. Phone/Fax

Practice location:
  • Phone: 414-231-3130
  • Fax: 414-239-8544
Mailing address:
  • Phone: 414-231-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SAHR A LEBBIE
Title or Position: CEO
Credential:
Phone: 414-231-3130