Healthcare Provider Details

I. General information

NPI: 1356902027
Provider Name (Legal Business Name): ANNA HOLLIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E HUDSON AVE
ROYAL OAK MI
48067-3711
US

IV. Provider business mailing address

313 E HUDSON AVE
ROYAL OAK MI
48067-3711
US

V. Phone/Fax

Practice location:
  • Phone: 248-677-1853
  • Fax:
Mailing address:
  • Phone: 248-677-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6301016907
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: