Provider Demographics
NPI:1649870783
Name:HOLISTIC HEALTH AND PSYCHIATRY
Entity type:Organization
Organization Name:HOLISTIC HEALTH AND PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMUSOH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-546-8000
Mailing Address - Street 1:4601 HOLLOW TREE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1288
Mailing Address - Country:US
Mailing Address - Phone:817-546-8000
Mailing Address - Fax:817-345-0465
Practice Address - Street 1:4601 HOLLOW TREE DR STE 111
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1288
Practice Address - Country:US
Practice Address - Phone:817-546-8000
Practice Address - Fax:817-345-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty