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NPI Code Detail

MEDICARE: THOMAS F HOLLER LPC, CADC

MEDICARE: THOMAS F HOLLER LPC, CADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor29796IL
2101YM0800XMental Health Counselor178.006639IL
3101YP2500XProfessional Counselor178.006639IL

General Provider Information

NPI Number : 1750656435
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS F HOLLER LPC, CADC
Provider Business Mailing Address
First Line : 5537 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1405
Country : US
Telephone Number : 773-989-9400
Fax Number : 773-989-9494
Provider Business Practice Location Address
First Line : 5537 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1405
Country : US
Telephone Number : 773-989-9400
Fax Number : 773-989-9494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2012
Last Update Date : 03/14/2012

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Directions to “ THOMAS F HOLLER LPC, CADC” Practice Location

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