Provider Demographics
NPI:1770308652
Name:HOLISTIC BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAKUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-213-9359
Mailing Address - Street 1:1821 UNIVERSITY AVE W # 205
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:763-213-9359
Mailing Address - Fax:651-780-7216
Practice Address - Street 1:1821 UNIVERSITY AVE W # 205
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:763-213-9359
Practice Address - Fax:651-780-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness