Provider Demographics
NPI:1255522645
Name:WHOLISTIC HEALTH ASSOCIATES
Entity type:Organization
Organization Name:WHOLISTIC HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-764-1743
Mailing Address - Street 1:10455 N CENTRAL EXPY
Mailing Address - Street 2:#109-325
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2213
Mailing Address - Country:US
Mailing Address - Phone:214-764-1743
Mailing Address - Fax:413-403-0023
Practice Address - Street 1:10455 N CENTRAL EXPY
Practice Address - Street 2:#109-325
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2213
Practice Address - Country:US
Practice Address - Phone:214-764-1743
Practice Address - Fax:413-403-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4442103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H53ROtherMEDICARE