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NPI Code Detail

MEDICARE: MRS. PHYLLIS W HOLLANDSWORTH LMFT

MEDICARE: MRS. PHYLLIS W HOLLANDSWORTH LMFT
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
1106H00000XMarriage & Family TherapistMT1581FL

General Provider Information

NPI Number : 1477659845
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PHYLLIS W HOLLANDSWORTH LMFT
Provider Business Mailing Address
First Line : PO BOX 9671
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32120-9671
Country : US
Telephone Number : 386-676-7100
Fax Number : 386-676-7125
Provider Business Practice Location Address
First Line : 1340 RIDGEWOOD AVE
Second Line :
City : HOLLY HILL
State : FL
Zip : 32117-2320
Country : US
Telephone Number : 386-676-7100
Fax Number : 386-676-7125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. PHYLLIS W HOLLANDSWORTH LMFT” Practice Location

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