Provider Demographics
NPI:1275409369
Name:WATER LILY HOLISTIC SERVICES
Entity type:Organization
Organization Name:WATER LILY HOLISTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRASOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:339-222-8101
Mailing Address - Street 1:2801 JEFFERSON ST APT 49
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4162
Mailing Address - Country:US
Mailing Address - Phone:339-222-8101
Mailing Address - Fax:
Practice Address - Street 1:2801 JEFFERSON ST APT 49
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4162
Practice Address - Country:US
Practice Address - Phone:339-222-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty