# HOLISTIC ATHLETE LLC

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

## Provider details

- **NPI number:** 1932834926
- **Authorized official:** ZACHARY ETTER LPC CMPC (CEO)
- **Authorized official phone:** (860) 877-6093

## Contact information

- **Practice address:** 24B ROSEMARY LN, MIDDLEFIELD, CT 06455-1041
- **Practice address phone:** (860) 877-6093
- **Mailing address:** 24B ROSEMARY LN, MIDDLEFIELD, CT 06455-1041
- **Mailing address phone:** (860) 877-6093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 103TE1100X | Exercise & Sports Psychologist | — | NULL | Yes |
| 103TE1100X | Exercise & Sports Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2022
- **Last updated:** 07/22/2022