Provider Demographics
NPI:1457947004
Name:HOLISTIC HEALING MIND BODY & SOUL LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALING MIND BODY & SOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSLEOR/MENTAL HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELICIA
Authorized Official - Middle Name:CHARLISSE
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PLHMP
Authorized Official - Phone:402-915-2159
Mailing Address - Street 1:2569 BROWNE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2046
Mailing Address - Country:US
Mailing Address - Phone:024-630-7649
Mailing Address - Fax:
Practice Address - Street 1:2569 BROWNE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2046
Practice Address - Country:US
Practice Address - Phone:402-630-7649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty