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General NPI Number Information
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NPI Number | 1306676069
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Entity Type | Organization
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Legal Business Name | HOLISTIC PSYCHOLOGY SERVICES LLC
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 189 W CLARKSTON RD
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City | LAKE ORION
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State | MI
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Zip | 48362-2892
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Country | US
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Telephone | 248-989-6128
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 PERRY LAKE RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-9210
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Country | US
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Telephone | 248-989-6128
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Fax |
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Authorized Official
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Title or Position | MASTER'S LEVEL PSYCHOLOGIST
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Name | BETHANY ANNE CRISP
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Credential | LLP
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Telephone | 248-989-6128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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