Healthcare Provider Details

I. General information

NPI: 1023057791
Provider Name (Legal Business Name): MICHAEL G. HOLLER L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92330 OVERSEAS HWY STE 103
TAVERNIER FL
33070-2700
US

IV. Provider business mailing address

127 PIRATES DR
KEY LARGO FL
33037-2321
US

V. Phone/Fax

Practice location:
  • Phone: 305-393-1230
  • Fax: 305-852-7479
Mailing address:
  • Phone: 305-393-1230
  • Fax: 305-853-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW002767
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: