Provider Demographics
NPI:1437724424
Name:HOLISTIC BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-444-1148
Mailing Address - Street 1:140 S ARTHUR ST STE 425
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2266
Mailing Address - Country:US
Mailing Address - Phone:713-444-1148
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST STE 425
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2266
Practice Address - Country:US
Practice Address - Phone:862-764-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61132735Medicaid