Provider Demographics
NPI:1285906198
Name:HOLISTIC PSYCHIATRY INC
Entity type:Organization
Organization Name:HOLISTIC PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENO
Authorized Official - Middle Name:K
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-942-8645
Mailing Address - Street 1:202 S PERSHING ST
Mailing Address - Street 2:PO BOX 490
Mailing Address - City:ENERGY
Mailing Address - State:IL
Mailing Address - Zip Code:62933
Mailing Address - Country:US
Mailing Address - Phone:618-942-8645
Mailing Address - Fax:618-942-8640
Practice Address - Street 1:202 S PERSHING ST
Practice Address - Street 2:
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933
Practice Address - Country:US
Practice Address - Phone:618-942-8645
Practice Address - Fax:618-942-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128348261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health