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General NPI Number Information
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NPI Number | 1760044929
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Entity Type | Organization
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Legal Business Name | HOLISTIC RESOURCES LLC
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 6 HAWKEYE DR STE 101
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8904
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Country | US
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Telephone | 319-665-2848
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Fax | 319-665-2849
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Provider Business Mailing Address
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Address Line | 6 HAWKEYE DR STE 101
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8904
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Country | US
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Telephone | 319-665-2848
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Fax | 319-665-2849
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. CHRISTINA E. STAI
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Credential | PSY.D.
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Telephone | 319-665-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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