Healthcare Provider Details

I. General information

NPI: 1376958199
Provider Name (Legal Business Name): GLORIA TEMPLE HOLLAND MA, LSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 CLIFF GOOKIN BLVD
TUPELO MS
38801-6558
US

IV. Provider business mailing address

247 OLD PLANTERS RD
PLANTERSVILLE MS
38862-6200
US

V. Phone/Fax

Practice location:
  • Phone: 662-584-5097
  • Fax: 662-495-4079
Mailing address:
  • Phone: 662-377-2865
  • Fax: 662-377-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0068
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW0111
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: