Provider Demographics
NPI:1962059949
Name:THE BODHI TREE HOLISTIC HEALING
Entity type:Organization
Organization Name:THE BODHI TREE HOLISTIC HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:785-312-0923
Mailing Address - Street 1:15 E 7TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2285
Mailing Address - Country:US
Mailing Address - Phone:785-813-1254
Mailing Address - Fax:
Practice Address - Street 1:15 E 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2285
Practice Address - Country:US
Practice Address - Phone:785-312-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty