| A Holistic Therapy Group Llc | |
|
4514 Cole Ave Ste 600 Dallas TX 75205-4193 | |
| (773) 203-7263 | |
| Not Available |
| Full Name | A Holistic Therapy Group Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4514 Cole Ave Ste 600, Dallas, Texas |
| Authorized Official Name and Position | Ashley A Nazon (OWNER) |
| Authorized Official Contact | 7732037263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Holistic Therapy Group Llc Po Box 6771 Brandon FL 33508-6013 Ph: (773) 203-7263 | A Holistic Therapy Group Llc 4514 Cole Ave Ste 600 Dallas TX 75205-4193 Ph: (773) 203-7263 |
| NPI Number | 1184257149 |
|---|---|
| Provider Enumeration Date | 02/18/2020 |
| Last Update Date | 10/23/2024 |
| Certification Date | 10/23/2024 |
| Medicare PECOS PAC ID | 1254752249 |
|---|---|
| Medicare Enrollment ID | O20200529000773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184257149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carolyn Redmond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376802520 PECOS PAC ID: 8426322892 Enrollment ID: I20170922003325 |
| Provider Name | Ashley Andrea Nazon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609335884 PECOS PAC ID: 2365775756 Enrollment ID: I20190618002114 |
| Provider Name | Xiomara N Alvarez Salamo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831557487 PECOS PAC ID: 7113359936 Enrollment ID: I20191118000549 |
| Provider Name | Brandon Bustamante |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366108128 PECOS PAC ID: 0345628640 Enrollment ID: I20220526002933 |
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