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Organization
HOLISTIC ATHLETE LLC
Active
Organization
HOLISTIC ATHLETE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY ETTER LPC CMPC (CEO)
(860) 877-6093
Entity
Organization
Contact information
Practice address
24B ROSEMARY LN, MIDDLEFIELD, CT 06455-1041
(860) 877-6093
Mailing address
24B ROSEMARY LN, MIDDLEFIELD, CT 06455-1041
(860) 877-6093
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
NULL
103TC1900X
Counseling Psychologist
—
—
103TE1100X
Exercise & Sports Psychologist
Primary
—
NULL
103TE1100X
Exercise & Sports Psychologist
Primary
—
—
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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