Basic Information
| Provider Information | |||||||||
| NPI: | 1770250425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | MFT-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26627 BRUCE RD | ||||||||
| Address2: | |||||||||
| City: | BAY VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441402204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404650166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22001 FAIRMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441184819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169322800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2021 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | M.2100228-TRNE | OH | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.