My Holistic Life, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MY HOLISTIC LIFE, LLC

Practice address

10454 Juneau Way
Collierville, TN 38017-1968

Phone

(901) 568-0442

Fax

(901) 284-0008

NPI assigned

Jul 30, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronda Mae Welty, COTA/L, CAPSNPI 1386824068

Title

Owner

Phone

(901) 568-0442

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• My Holistic Life, LLC Other name

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronda M Welty

  • Occupational Therapy Assistant
  • West Memphis, AR
  • NPI 1386824068
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1366051823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10454 JUNEAU WAY",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380171968",
            "telephone_number": "901-568-0442",
            "fax_number": "901-284-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10454 JUNEAU WAY",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380171968",
            "telephone_number": "901-568-0442",
            "fax_number": "901-284-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY HOLISTIC LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "WELTY",
        "authorized_official_first_name": "RONDA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-568-0442",
        "authorized_official_credential": "COTA/L, CAPS"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTA LICENSE",
            "identifier": "1286",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@myholistic.life",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "day to day business information",
            "address_1": "10454 Juneau Way",
            "city": "Collierville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "380171968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "My Holistic Life, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• MTG Financial Services and Assoc.
• Edward Simmons Muir, M.D.
• Tonie Mullen, FNP
• William Gregory Mullinax, M.D.
• Sara Murphy
• Matthew Carter Myatt, LPC-MHSP
• Myeyedr Optometry of Tennessee, LLC
• Saraswathy B Naren, DO
• National Vision Inc
• Natural Potential Chiropractic, LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Collierville, TN
• Providers in Collierville, TN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.