Provider Demographics
NPI:1225868607
Name:MY WALDEN MASSAGE & HOLISTIC HEALTH SERVICES, LLC.
Entity type:Organization
Organization Name:MY WALDEN MASSAGE & HOLISTIC HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, BCTMB, CSSI
Authorized Official - Phone:601-401-4930
Mailing Address - Street 1:PO BOX 1113
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1113
Mailing Address - Country:US
Mailing Address - Phone:601-401-4930
Mailing Address - Fax:
Practice Address - Street 1:7048 OLD CANTON RD STE 2011
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1008
Practice Address - Country:US
Practice Address - Phone:601-401-4930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty