Provider Demographics
NPI:1760044929
Name:HOLISTIC RESOURCES LLC
Entity Type:Organization
Organization Name:HOLISTIC RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:319-665-2848
Mailing Address - Street 1:6 HAWKEYE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8904
Mailing Address - Country:US
Mailing Address - Phone:319-665-2848
Mailing Address - Fax:319-665-2849
Practice Address - Street 1:6 HAWKEYE DR STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8904
Practice Address - Country:US
Practice Address - Phone:319-665-2848
Practice Address - Fax:319-665-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty