Provider Demographics
NPI:1487482790
Name:MONTGOMERY HOLISTIC WELLNESS
Entity type:Organization
Organization Name:MONTGOMERY HOLISTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-538-9457
Mailing Address - Street 1:3263 ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-3920
Mailing Address - Country:US
Mailing Address - Phone:334-538-9457
Mailing Address - Fax:
Practice Address - Street 1:4758 WOODMERE BLVD STE F5063
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3075
Practice Address - Country:US
Practice Address - Phone:334-603-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty