Provider Demographics
NPI:1487077897
Name:HOLISTIX MEDICAL GROUP
Entity type:Organization
Organization Name:HOLISTIX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:561-213-4103
Mailing Address - Street 1:1815 E COMMERCIAL BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3760
Mailing Address - Country:US
Mailing Address - Phone:954-941-3413
Mailing Address - Fax:754-200-6283
Practice Address - Street 1:1815 E COMMERCIAL BLVD
Practice Address - Street 2:STE 206
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3760
Practice Address - Country:US
Practice Address - Phone:954-941-3413
Practice Address - Fax:754-200-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty