Provider Demographics
NPI:1225212343
Name:HOLISTIC PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:HOLISTIC PSYCHOLOGICAL CENTER
Other - Org Name:NAKAIA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-653-5081
Mailing Address - Street 1:72 N MAIN ST
Mailing Address - Street 2:ROOM 210
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2870
Mailing Address - Country:US
Mailing Address - Phone:330-653-5081
Mailing Address - Fax:330-653-5823
Practice Address - Street 1:72 N MAIN ST
Practice Address - Street 2:ROOM 210
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2870
Practice Address - Country:US
Practice Address - Phone:330-653-5081
Practice Address - Fax:330-653-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP23421Medicare PIN