Basic Information
| Provider Information | |||||||||
| NPI: | 1134556160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLERS | ||||||||
| FirstName: | HAILEY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | M.A., AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6186 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928160186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098518028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 405 W 5TH ST # 658 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148345015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2013 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 92132 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103T00000X | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | MFTI92132 | 01 | CA | MARRIAGE AND FAMILY THERAPIST | OTHER |