Healthcare Provider Details

I. General information

NPI: 1396779724
Provider Name (Legal Business Name): PATRICIA B HOLLIDAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA BOYE PH.D.

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 E CAPITOL ST 840 TRUST MARK BLDG
JACKSON MS
39201-2503
US

IV. Provider business mailing address

104 CEDAR RIDGE RD
MCCOMB MS
39648-2100
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 601-648-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number46748
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: