Healthcare Provider Details

I. General information

NPI: 1568373207
Provider Name (Legal Business Name): TIMOTHY THOMAS HOLLER II LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMMY HOLLER LADC

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7611
US

IV. Provider business mailing address

5511 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7611
US

V. Phone/Fax

Practice location:
  • Phone: 615-994-1000
  • Fax: 615-994-0100
Mailing address:
  • Phone: 615-994-1000
  • Fax: 615-994-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: