Provider Demographics
NPI:1033773734
Name:HOLISTIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:HOLISTIC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:608-291-5891
Mailing Address - Street 1:1517 E HUEBBE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1795
Mailing Address - Country:US
Mailing Address - Phone:608-291-5891
Mailing Address - Fax:608-713-9040
Practice Address - Street 1:1517 HUEBBE PARKWAY
Practice Address - Street 2:STE A
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-291-5891
Practice Address - Fax:608-713-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100096899Medicaid