Basic Information
| Provider Information | |||||||||
| NPI: | 1295065506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CHAD | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4217 N OLD STAGE RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT SHASTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960679131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309499094 | ||||||||
| FaxNumber: | 5302416541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1614 CONTINENTAL ST STE B | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960011121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302415999 | ||||||||
| FaxNumber: | 5302416541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2010 | ||||||||
| LastUpdateDate: | 01/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT47764 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.