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General NPI Number Information
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NPI Number | 1316778855
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Entity Type | Organization
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Legal Business Name | HOLISTIC PSYCHIATRY PC
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 2327 70TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-4825
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Country | US
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Telephone | 515-518-0460
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Fax | 515-777-1950
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Provider Business Mailing Address
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Address Line | 2327 70TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-4825
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Country | US
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Telephone | 515-518-0460
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Fax | 515-777-1950
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAYSON GESULGA
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Credential |
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Telephone | 515-518-0460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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