Provider Demographics
NPI:1477171965
Name:HOLISTIC INTEGRATIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:HOLISTIC INTEGRATIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-276-0279
Mailing Address - Street 1:1317 EDGEWATER DR # 1707
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:651-307-7652
Mailing Address - Fax:407-264-6834
Practice Address - Street 1:1317 EDGEWATER DR # 1707
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:651-307-7652
Practice Address - Fax:407-264-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health