Doctor Name: | PATRICIA HOLLISTER |
NPI Number: | 1134164494 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMFT |
License Number: | 4562 |
Business Practice Address: | 1208 New York Ave Alamogordo, NM - 883106728 |
Business Phone Number: | 5054378865 |
Business Fax Number: | 5054371446 |
Mailing Address: | Po Box 666, CLOUDCROFT |
State: | NM |
Postal Code: | 883170666 |
Phone Number: | 5054378865 |
Fax Number: | 5054371446 |
NPI Enumeration Date: | 06/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |