MEDICARE: ELLEN ELIZABETH HOLBROOK MA

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	CC00843	MN
2	101YP2500X	Professional Counselor	CP0150	NV

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	:	1881936284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ELIZABETH HOLBROOK MA

Provider Business Mailing Address
First Line	:	3732 LAKESIDE DR STE 202
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-4519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3732 LAKESIDE DR STE 202
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-4519
Country	:	US
Telephone Number	:	320-905-4345
Fax Number	:	507-299-0436

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

Provider Enumeration Date	:	03/23/2013
Last Update Date	:	08/20/2021

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