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General NPI Number Information
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NPI Number | 1477449692
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Entity Type | Organization
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Legal Business Name | HOLISTIC HAVEN L.L.C.
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 09/14/2025
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Provider Practice Location Address
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Address Line | 332 S MICHIGAN AVE STE 900
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City | CHICAGO
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State | IL
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Zip | 60604-4393
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Country | US
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Telephone | 773-242-8407
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Fax |
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Provider Business Mailing Address
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Address Line | 332 S MICHIGAN AVE STE 900
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City | CHICAGO
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State | IL
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Zip | 60604-4393
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Country | US
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Telephone | 773-923-3103
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Fax | 773-200-3820
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL GOODS
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Credential | PMHNP
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Telephone | 773-242-8407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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