Provider Demographics
NPI:1457103103
Name:HOLISTIC BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ORNELA
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:IKA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-NP
Authorized Official - Phone:314-600-5221
Mailing Address - Street 1:101 LONG PASS CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-5051
Mailing Address - Country:US
Mailing Address - Phone:314-600-5221
Mailing Address - Fax:
Practice Address - Street 1:101 LONG PASS CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-5051
Practice Address - Country:US
Practice Address - Phone:314-600-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty