Provider Demographics
NPI:1316340458
Name:HOLISTIC PSYCHIATRY
Entity type:Organization
Organization Name:HOLISTIC PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOVANEC
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:440-867-8283
Mailing Address - Street 1:13637 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2639
Mailing Address - Country:US
Mailing Address - Phone:440-867-8283
Mailing Address - Fax:
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:MEDICAL ARTS CENTER 4, SUITE 204
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129
Practice Address - Country:US
Practice Address - Phone:440-743-2128
Practice Address - Fax:440-743-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16196261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health