Healthcare Provider Details

I. General information

NPI: 1811960644
Provider Name (Legal Business Name): KERRY L. HOLLAND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 UNIVERSITY PKWY 139 LUCILLE CLEMENT HALL
JOHNSON CITY TN
37614-6500
US

IV. Provider business mailing address

807 UNIVERSITY PKWY BOX 70416, ETSU
JOHNSON CITY TN
37614-6500
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-7778
  • Fax: 423-439-7780
Mailing address:
  • Phone: 423-439-7778
  • Fax: 423-439-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000002099
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: