Basic Information
| Provider Information | |||||||||
| NPI: | 1306122486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIELD | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA/PLHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693600779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083272026 | ||||||||
| FaxNumber: | 3083272126 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 WEST 3RD STREET | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 69360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083272026 | ||||||||
| FaxNumber: | 3083272126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2011 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9479 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.