MEDICARE: BRENT HOLLADAY M.A.

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
1	106H00000X	Marriage & Family Therapist	MT 3157	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225487408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT HOLLADAY M.A.

Provider Business Mailing Address
First Line	:	915 OLD DIXIE HWY SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-5618
Country	:	US
Telephone Number	:	772-643-5849
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 OLD DIXIE HWY SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-5618
Country	:	US
Telephone Number	:	772-643-5849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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Directions to “ BRENT HOLLADAY M.A.” Practice Location

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