Provider Demographics
NPI:1154077469
Name:TRILOGY HOLISTIC WELLNESS
Entity Type:Organization
Organization Name:TRILOGY HOLISTIC WELLNESS
Other - Org Name:TRILOGY HOLISTIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZIPPORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-624-6043
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-0181
Mailing Address - Country:US
Mailing Address - Phone:313-908-0507
Mailing Address - Fax:
Practice Address - Street 1:220 W CONGRESS ST FL 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3289
Practice Address - Country:US
Practice Address - Phone:313-908-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)