Provider Demographics
NPI:1659556074
Name:HOLISTIC PSYCH CENTER CORP.
Entity Type:Organization
Organization Name:HOLISTIC PSYCH CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-373-2667
Mailing Address - Street 1:569 HAO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1645
Mailing Address - Country:US
Mailing Address - Phone:808-373-2667
Mailing Address - Fax:808-373-2810
Practice Address - Street 1:569 HAO ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1645
Practice Address - Country:US
Practice Address - Phone:808-373-2667
Practice Address - Fax:808-373-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty