1104509140 NPI number — HOLISTIC WELLNESS & PSYCHIATRY

Table of content: (NPI 1104509140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104509140 NPI number — HOLISTIC WELLNESS & PSYCHIATRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC WELLNESS & PSYCHIATRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104509140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 7TH AVE SW STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52404-2185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-800-2125
Provider Business Mailing Address Fax Number:
855-300-4759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9150 ESTATE THOMAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-224-9658
Provider Business Practice Location Address Fax Number:
855-300-4759
Provider Enumeration Date:
08/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
MAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
319-471-1749

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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