Provider Demographics
NPI:1811146855
Name:HOLISTIC THERAPY
Entity type:Organization
Organization Name:HOLISTIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEAVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CADCI
Authorized Official - Phone:620-340-0317
Mailing Address - Street 1:1101 COMMERCIAL STREET
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2989
Mailing Address - Country:US
Mailing Address - Phone:620-340-0317
Mailing Address - Fax:620-343-3033
Practice Address - Street 1:1101 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2989
Practice Address - Country:US
Practice Address - Phone:620-340-0317
Practice Address - Fax:620-343-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health