Provider Demographics
NPI:1891270120
Name:HOLISTIC TELEMENTAL HEALTH
Entity Type:Organization
Organization Name:HOLISTIC TELEMENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:ROMAN MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LPC , LMHC
Authorized Official - Phone:413-885-4335
Mailing Address - Street 1:174 SOUTH RD STE 112
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4414
Mailing Address - Country:US
Mailing Address - Phone:860-698-0782
Mailing Address - Fax:413-455-2708
Practice Address - Street 1:174 SOUTH RD STE 112
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4414
Practice Address - Country:US
Practice Address - Phone:860-698-0782
Practice Address - Fax:413-455-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1851686000Medicaid