Provider Demographics
NPI:1073214086
Name:THE HOLISTIC BEHAVIORIST
Entity Type:Organization
Organization Name:THE HOLISTIC BEHAVIORIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MED,BCBA,CTP
Authorized Official - Phone:302-562-0735
Mailing Address - Street 1:1506 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3104
Mailing Address - Country:US
Mailing Address - Phone:302-562-0735
Mailing Address - Fax:
Practice Address - Street 1:1506 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3104
Practice Address - Country:US
Practice Address - Phone:302-562-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health