Healthcare Provider Details

I. General information

NPI: 1124130158
Provider Name (Legal Business Name): HOLLIS HOLLY KADESH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY KADESH

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 NW HUGHWOOD CT
ROSEBURG OR
97471-8844
US

IV. Provider business mailing address

110 S PARK CT
ROSEBURG OR
97471-8121
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-3985
  • Fax: 541-673-8060
Mailing address:
  • Phone: 406-671-4772
  • Fax: 541-673-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC36003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1236LCPC
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: