Provider Demographics
NPI:1144063900
Name:HOLISTIC HEALING CENTER LLC
Entity type:Organization
Organization Name:HOLISTIC HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-669-3506
Mailing Address - Street 1:7075 W BELL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8547
Mailing Address - Country:US
Mailing Address - Phone:602-669-3506
Mailing Address - Fax:
Practice Address - Street 1:7075 W BELL RD STE 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8547
Practice Address - Country:US
Practice Address - Phone:714-926-5547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty