Provider Demographics
NPI:1619418753
Name:HOLISTIC HEALING LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAZE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CDP
Authorized Official - Phone:715-587-8528
Mailing Address - Street 1:1444 ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1578
Mailing Address - Country:US
Mailing Address - Phone:715-587-8528
Mailing Address - Fax:608-819-6334
Practice Address - Street 1:1444 ELLEN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1578
Practice Address - Country:US
Practice Address - Phone:715-587-8528
Practice Address - Fax:608-819-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI226773261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service