MEDICARE: ITS HOLISTIC THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205675329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITS HOLISTIC THERAPY LLC

Provider Business Mailing Address
First Line	:	6501 ARLINGTON EXPY STE 109
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-855-7084
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 ARLINGTON EXPY STE 109
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-208-0760
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TANITHA NICHOLAS
Credential	:
Telephone Number	:	904-208-0760

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	10/22/2025

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Directions to “ITS HOLISTIC THERAPY LLC ” Practice Location

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