Organization
MY HOLISTIC LIFE, LLC
Active
Organization
MY HOLISTIC LIFE, LLC
Active
Other names
My Holistic Life, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RONDA MAE WELTY COTA/L, CAPS (OWNER)
(901) 568-0442
Entity
Organization
Contact information
Practice address
10454 JUNEAU WAY, COLLIERVILLE, TN 38017-1968
(901) 568-0442
(901) 284-0008
Mailing address
10454 JUNEAU WAY, COLLIERVILLE, TN 38017-1968
(901) 568-0442
(901) 284-0008
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1286
OTA LICENSE
TN
Enumeration date
07/30/2020
Last updated
07/30/2020
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