Provider Demographics
NPI:1306676069
Name:HOLISTIC PSYCHOLOGY SERVICES LLC
Entity type:Organization
Organization Name:HOLISTIC PSYCHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER'S LEVEL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-989-6128
Mailing Address - Street 1:2450 PERRY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9210
Mailing Address - Country:US
Mailing Address - Phone:248-989-6128
Mailing Address - Fax:
Practice Address - Street 1:189 W CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2892
Practice Address - Country:US
Practice Address - Phone:248-989-6128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty