Healthcare Provider Details

I. General information

NPI: 1942128277
Provider Name (Legal Business Name): MICHAELA HOLLOWAY PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

601 STADIUM MALL DR
WEST LAFAYETTE IN
47907-2052
US

IV. Provider business mailing address

601 STADIUM MALL DR
WEST LAFAYETTE IN
47907-2052
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-6995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20044093B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: