Provider Demographics
NPI:1144082231
Name:HOLISTIC LIVING LLC.
Entity type:Organization
Organization Name:HOLISTIC LIVING LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:260-255-6897
Mailing Address - Street 1:14307 RAMONA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9646
Mailing Address - Country:US
Mailing Address - Phone:260-255-6897
Mailing Address - Fax:
Practice Address - Street 1:14307 RAMONA LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9646
Practice Address - Country:US
Practice Address - Phone:260-255-6897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty