Healthcare Provider Details

I. General information

NPI: 1467514752
Provider Name (Legal Business Name): JAMES MARTIN HOLLOMON JD, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMIE MARTIN HOLLOMON JD, MFT

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 VAN NESS AVE
SANTA CRUZ CA
95060-4200
US

IV. Provider business mailing address

446 LOCUST ST
SANTA CRUZ CA
95060-3644
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-8178
  • Fax:
Mailing address:
  • Phone: 831-454-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37788
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberMFC37788
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMFC37788
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMFC37788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: