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General NPI Number Information
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NPI Number | 1003078437
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Entity Type | Organization
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Legal Business Name | HOLLIST TREATMENT FOR ADOLESCENTS AND FAMILIES
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 2111 W MULBERRY ST
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City | LINCOLN
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State | NE
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Zip | 68522-1421
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Country | US
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Telephone | 402-202-0577
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Fax | 402-438-5330
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Provider Business Mailing Address
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Address Line | 2111 W MULBERRY ST
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City | LINCOLN
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State | NE
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Zip | 68522-1421
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Country | US
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Telephone | 402-202-0577
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Fax | 402-438-5330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CODY STONEWALL HOLLIST
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Credential | PH.D, LIMHP, LIMFT
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Telephone | 402-202-0506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 272
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License Number State | NE
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