Provider Demographics
NPI:1316414790
Name:HOLISTIC MENTAL HEALTH WELLNESS INC
Entity type:Organization
Organization Name:HOLISTIC MENTAL HEALTH WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANGEE
Authorized Official - Middle Name:XIMENA
Authorized Official - Last Name:MOSCOSO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:224-366-7537
Mailing Address - Street 1:10 MONARCH DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-4521
Mailing Address - Country:US
Mailing Address - Phone:224-366-7537
Mailing Address - Fax:
Practice Address - Street 1:10 MONARCH DR UNIT B
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-4521
Practice Address - Country:US
Practice Address - Phone:224-366-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLISTIC MENTAL HEALTH WELLNESS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332702628Medicaid