Healthcare Provider Details

I. General information

NPI: 1205715166
Provider Name (Legal Business Name): HEATHER MARIE HOLLOMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-3502
US

IV. Provider business mailing address

1440 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-3502
US

V. Phone/Fax

Practice location:
  • Phone: 616-633-8704
  • Fax:
Mailing address:
  • Phone: 616-633-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0022194
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: