Provider Demographics
NPI:1053058032
Name:WHOLE BODY PSYCHOTHERAPY
Entity Type:Organization
Organization Name:WHOLE BODY PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KACZUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-417-8777
Mailing Address - Street 1:4500 WILLIAMS DR STE 212-158
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1332
Mailing Address - Country:US
Mailing Address - Phone:609-417-8777
Mailing Address - Fax:
Practice Address - Street 1:4500 WILLIAMS DR STE 212-158
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1332
Practice Address - Country:US
Practice Address - Phone:609-417-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457929655OtherPRIVATE INSURANCE