# WONDERFUL COUNSELOR HOLISTIC PSYCHIATRIC CARE A PROFESSIONAL NU

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447076690
- **Authorized official:** MISS AHILA MUTHAIYA (OWNER)
- **Authorized official phone:** (314) 974-7347

## Contact information

- **Practice address:** 4368 EAGLE ROCK BLVD, LOS ANGELES, CA 90041-3211
- **Practice address phone:** (314) 974-7347
- **Practice address fax:** (314) 843-0201
- **Mailing address:** 4368 EAGLE ROCK BLVD, LOS ANGELES, CA 90041-3211
- **Mailing address phone:** (314) 974-7347
- **Mailing address fax:** (314) 843-0201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2024
- **Last updated:** 12/19/2024