MEDICARE: MRS. NANCY D HOLLAND LPE

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	101YP2500X	Professional Counselor	CPC1377	TN
2	103TS0200X	School Psychologist	PE01456	TN

General Provider Information

NPI Number	:	1508988049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY D HOLLAND LPE

Provider Business Mailing Address
First Line	:	4211 GREEN SHANTY RD
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-8443
Country	:	US
Telephone Number	:	423-894-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 LEE HWY
Second Line	:	SUITE 205
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3546
Country	:	US
Telephone Number	:	423-894-6588
Fax Number	:	423-894-2957

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	09/11/2025

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