Provider Demographics
NPI:1962793166
Name:HOLISTIC HEALING ARTS PLLC
Entity type:Organization
Organization Name:HOLISTIC HEALING ARTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:DERKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-582-7678
Mailing Address - Street 1:19217 36TH AVE WEST
Mailing Address - Street 2:BLDG 5, SUITE 106
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-582-7678
Mailing Address - Fax:425-582-7032
Practice Address - Street 1:19217 36TH AVE WEST
Practice Address - Street 2:BLDG 5, SUITE 106
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-582-7678
Practice Address - Fax:425-582-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001250175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty