MEDICARE: HOLISTIC MEDICAL GROUP

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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1922426956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC MEDICAL GROUP

Provider Business Mailing Address
First Line	:	445 E HUBER ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-3645
Country	:	US
Telephone Number	:	480-969-1471
Fax Number	:	480-269-9426

Provider Business Practice Location Address
First Line	:	32 S MACDONALD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-1310
Country	:	US
Telephone Number	:	480-969-1472
Fax Number	:	480-269-9426

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN SCHWARY
Credential	:
Telephone Number	:	480-969-1471

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	06/18/2014

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Directions to “HOLISTIC MEDICAL GROUP ” Practice Location

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