Organization
WHOLISTIC THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMIE V. TANNER (OPERATIONS MANAGER)
(229) 396-4689
Entity
Organization
Contact information
Practice address
911 MAIN ST S, TIFTON, GA 31794-4867
(229) 396-4689
(229) 396-4605
Mailing address
PO BOX 1743, TIFTON, GA 31793-1743
(229) 396-4689
(229) 396-4605
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003189286A
—
GA
Enumeration date
08/02/2020
Last updated
08/02/2020
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