MEDICARE: SHEILA HOLLOWAY LPC-IT

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	101YM0800X	Mental Health Counselor	7243226	WI
2	101YP2500X	Professional Counselor	7243226	WI

General Provider Information

NPI Number	:	1669172250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA HOLLOWAY LPC-IT

Provider Business Mailing Address
First Line	:	1512 N WARREN AVE APT 206
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W VIRGINIA ST STE 204
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1549
Country	:	US
Telephone Number	:	414-207-4565
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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Directions to “ SHEILA HOLLOWAY LPC-IT” Practice Location

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