Healthcare Provider Details

I. General information

NPI: 1215485859
Provider Name (Legal Business Name): MANDY HOLLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL MAILSTOP: A011
AURORA CO
80045-2570
US

IV. Provider business mailing address

13001 E 17TH PL MAILSTOP: A011
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1000
  • Fax:
Mailing address:
  • Phone: 303-724-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924465
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: