=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558944488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIK THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2021
-----------------------------------------------------
Last Update Date | 08/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14637 FLAMINGO RD
-----------------------------------------------------
City | LOXAHATCHEE GROVES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-218-8383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14637 FLAMINGO RD
-----------------------------------------------------
City | LOXAHATCHEE GROVES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-218-8383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINCIAN/OWNER
-----------------------------------------------------
Name | SILVIA ALMEIDA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 201-218-8383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------