Provider Demographics
NPI:1073828505
Name:HOLISTIC BALANCE
Entity Type:Organization
Organization Name:HOLISTIC BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAFFY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GROW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-266-2418
Mailing Address - Street 1:PO BOX 18415
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-0415
Mailing Address - Country:US
Mailing Address - Phone:801-266-2418
Mailing Address - Fax:801-266-3358
Practice Address - Street 1:865 E 4800 S
Practice Address - Street 2:STE 222
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5043
Practice Address - Country:US
Practice Address - Phone:801-266-2418
Practice Address - Fax:801-266-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty