=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093796013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMI LEE HOLLER PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1990 3RD ST SUITE 600
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95814-6929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-457-2234
-----------------------------------------------------
Fax | 916-444-6054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4524 BABICH AVE
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95822-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-457-2234
-----------------------------------------------------
Fax | 916-444-6054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT 37120
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------