Healthcare Provider Details

I. General information

NPI: 1841521382
Provider Name (Legal Business Name): JAMES GRANT HOLLENBACH PCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771B STATE ROUTE 97
PERRYSVILLE OH
44864-9501
US

IV. Provider business mailing address

771B STATE ROUTE 97
PERRYSVILLE OH
44864-9501
US

V. Phone/Fax

Practice location:
  • Phone: 419-606-5046
  • Fax: 419-994-5145
Mailing address:
  • Phone: 419-606-5046
  • Fax: 419-994-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0701080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: