Provider Demographics
NPI:1346697224
Name:HOLISTIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:HOLISTIC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREDENNICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC, ADS
Authorized Official - Phone:203-240-9476
Mailing Address - Street 1:663 WEST AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-3062
Mailing Address - Country:US
Mailing Address - Phone:203-240-9476
Mailing Address - Fax:
Practice Address - Street 1:663 WEST AVE APT 24
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-3062
Practice Address - Country:US
Practice Address - Phone:203-240-9476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1105101YA0400X
CT2050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid