Healthcare Provider Details

I. General information

NPI: 1134164494
Provider Name (Legal Business Name): PATRICIA HOLLISTER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 NEW YORK AVE
ALAMOGORDO NM
88310-6728
US

IV. Provider business mailing address

PO BOX 666
CLOUDCROFT NM
88317-0666
US

V. Phone/Fax

Practice location:
  • Phone: 505-437-8865
  • Fax: 505-437-1446
Mailing address:
  • Phone: 505-437-8865
  • Fax: 505-437-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4562
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: