Provider Demographics
NPI:1316709652
Name:HOLISTIC PSYCHOTHERAPY INC
Entity type:Organization
Organization Name:HOLISTIC PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GEZERSEH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-463-2515
Mailing Address - Street 1:2149 RONDA GRANADA
Mailing Address - Street 2:UNIT A
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637
Mailing Address - Country:US
Mailing Address - Phone:949-463-2515
Mailing Address - Fax:949-484-8931
Practice Address - Street 1:23331 EL TORO ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:949-463-2515
Practice Address - Fax:949-484-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty