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NPI Code Detail

MEDICARE: KRANEISHA RENEE HOLLOWAY LAC

MEDICARE: KRANEISHA RENEE HOLLOWAY LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLAC17711AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LAC17711OTHERAZLAC

General Provider Information

NPI Number : 1023610557
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRANEISHA RENEE HOLLOWAY LAC
Provider Business Mailing Address
First Line : 2022 N NAVADA ST
Second Line : 1213
City : CHANDLER
State : AZ
Zip : 85226
Country : US
Telephone Number : 480-487-9098
Fax Number :
Provider Business Practice Location Address
First Line : 4330 E UNIVERSITY DR
Second Line :
City : MESA
State : AZ
Zip : 85205-7004
Country : US
Telephone Number : 480-296-3546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2020
Last Update Date : 11/10/2020

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Directions to “ KRANEISHA RENEE HOLLOWAY LAC” Practice Location

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