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General NPI Number Information
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NPI Number | 1902306269
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Entity Type | Organization
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Legal Business Name | HOLOS CONSULTING, LLC
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 230 W CENTER ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5934
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Country | US
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Telephone | 479-688-3688
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Fax | 866-649-6788
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Provider Business Mailing Address
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Address Line | 230 W CENTER ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5934
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Country | US
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Telephone | 479-688-3688
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Fax | 866-649-6788
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA M LEEK
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Credential | MA, LMFT, LPC
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Telephone | 479-668-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | M1303002
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License Number State | AR
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