Healthcare Provider Details

I. General information

NPI: 1629341797
Provider Name (Legal Business Name): KATHRYN M. HOLLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST B2109
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-630-2617
  • Fax: 317-630-2587
Mailing address:
  • Phone: 317-274-1201
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001646
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: