| Holistic Athlete Llc | |
|
24b Rosemary Ln Middlefield CT 06455-1041 | |
| (860) 877-6093 | |
| Not Available |
| Full Name | Holistic Athlete Llc |
|---|---|
| Speciality | Psychologist - Exercise & Sports |
| Location | 24b Rosemary Ln, Middlefield, Connecticut |
| Authorized Official Name and Position | Zachary Etter (CEO) |
| Authorized Official Contact | 8608776093 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Holistic Athlete Llc 24b Rosemary Ln Middlefield CT 06455-1041 Ph: (860) 877-6093 | Holistic Athlete Llc 24b Rosemary Ln Middlefield CT 06455-1041 Ph: (860) 877-6093 |
| NPI Number | 1932834926 |
|---|---|
| Provider Enumeration Date | 07/22/2022 |
| Last Update Date | 07/22/2022 |
| Certification Date | 07/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932834926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| 103TE1100X | Psychologist - Exercise & Sports | (* (Not Available)) | Primary |
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