Provider Demographics
NPI:1184395410
Name:HOLISTIC PSYCHIATRY
Entity type:Organization
Organization Name:HOLISTIC PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-582-0500
Mailing Address - Street 1:680 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1801
Mailing Address - Country:US
Mailing Address - Phone:313-574-8579
Mailing Address - Fax:
Practice Address - Street 1:4050 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2534
Practice Address - Country:US
Practice Address - Phone:313-574-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty