Provider Demographics
NPI:1417662586
Name:LUX AETERNA HOLISTIC THERAPY
Entity Type:Organization
Organization Name:LUX AETERNA HOLISTIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MLP
Authorized Official - Phone:616-834-5648
Mailing Address - Street 1:348 S WAVERLY RD STE 126
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8102
Mailing Address - Country:US
Mailing Address - Phone:616-834-5648
Mailing Address - Fax:
Practice Address - Street 1:348 S WAVERLY RD STE 126
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-8102
Practice Address - Country:US
Practice Address - Phone:616-834-5648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty