Provider Demographics
NPI:1790317659
Name:HOLISTIC THERAPY SERVICES
Entity Type:Organization
Organization Name:HOLISTIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-629-0464
Mailing Address - Street 1:7116 CLINTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5212
Mailing Address - Country:US
Mailing Address - Phone:856-629-0464
Mailing Address - Fax:
Practice Address - Street 1:7116 CLINTON RD STE A
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5212
Practice Address - Country:US
Practice Address - Phone:856-629-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health