Healthcare Provider Details

I. General information

NPI: 1033754551
Provider Name (Legal Business Name): TAYLOR ANNE VAN HOLLAND LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 SHOUP AVE W STE C
TWIN FALLS ID
83301-5050
US

IV. Provider business mailing address

526 SHOUP AVE W STE C
TWIN FALLS ID
83301-5050
US

V. Phone/Fax

Practice location:
  • Phone: 208-738-3147
  • Fax:
Mailing address:
  • Phone: 208-738-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-7527
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-7527
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: