Provider Demographics
NPI:1992286900
Name:HOLISTIC COACHING TREATMENT CENTER
Entity type:Organization
Organization Name:HOLISTIC COACHING TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF PROGRAMMING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNET
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:RCSWI
Authorized Official - Phone:727-678-1751
Mailing Address - Street 1:3510 1ST AVE S # 226
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1304
Mailing Address - Country:US
Mailing Address - Phone:727-678-1751
Mailing Address - Fax:
Practice Address - Street 1:3510 1ST AVE S # 226
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1304
Practice Address - Country:US
Practice Address - Phone:727-678-1751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH79471041C0700X
FLME1061652084A0401X, 2084P0802X
FLISW11776101YA0400X, 1041C0700X, 324500000X, 320800000X
FLARNP9400491251S00000X, 363LC1500X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063865608Medicaid
FL1871048314Medicaid
FL1346559820Medicaid
FL1407055171Medicaid