Provider Demographics
NPI:1316778855
Name:HOLISTIC PSYCHIATRY PC
Entity type:Organization
Organization Name:HOLISTIC PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GESULGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-518-0460
Mailing Address - Street 1:2327 70TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4825
Mailing Address - Country:US
Mailing Address - Phone:515-518-0460
Mailing Address - Fax:515-777-1950
Practice Address - Street 1:2327 70TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4825
Practice Address - Country:US
Practice Address - Phone:515-518-0460
Practice Address - Fax:515-777-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty