Provider Demographics
NPI:1902308604
Name:HOLISTIC BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH, LLC
Other - Org Name:HOLISTIC BEHAVIORAL HEALTH, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA'SHONDRA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:DA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-243-0060
Mailing Address - Street 1:81 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3352
Mailing Address - Country:US
Mailing Address - Phone:203-243-0060
Mailing Address - Fax:
Practice Address - Street 1:1700 DIXWELL AVE UNIT D
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3147
Practice Address - Country:US
Practice Address - Phone:203-604-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003264101YP2500X
101YP2500X, 1041C0700X, 106H00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1124445663Medicaid