Provider Demographics
NPI:1073214086
Name:THE HOLISTIC BEHAVIORIST
Entity type:Organization
Organization Name:THE HOLISTIC BEHAVIORIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MED,BCBA,CTP
Authorized Official - Phone:302-562-0735
Mailing Address - Street 1:1506 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3104
Mailing Address - Country:US
Mailing Address - Phone:302-562-0735
Mailing Address - Fax:
Practice Address - Street 1:1506 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3104
Practice Address - Country:US
Practice Address - Phone:302-562-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty