Provider Demographics
NPI:1144697830
Name:HOLISTIC ELEMENTS
Entity type:Organization
Organization Name:HOLISTIC ELEMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GROW
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-656-8030
Mailing Address - Street 1:835 EAST 4800 SOUTH SUITE 220
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-262-5418
Mailing Address - Fax:801-262-5468
Practice Address - Street 1:151 E 5600 S STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8150
Practice Address - Country:US
Practice Address - Phone:801-262-5418
Practice Address - Fax:801-262-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center