NPI Code Detail JSON Logo

1124130158 NPI number — HOLLIS HOLLY KADESH LPC

NPI Number: 1124130158
Health Care Provider/Practitioner: HOLLIS HOLLY KADESH LPC

Information about “1124130158” NPI (HOLLIS HOLLY KADESH LPC) exists in 1124130158 in HTML format HTML  |  1124130158 in plain Text format TXT  |  1124130158 in PDF (Portable Document Format) PDF  |  1124130158 in an XML format XML  formats.

NPI Number : 1124130158 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124130158",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KADESH",
    "FirstName": "HOLLIS",
    "MiddleName": "HOLLY",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KADESH",
    "OtherFirstName": "HOLLY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "110 S PARK CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSEBURG",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97471-8121",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-671-4772",
    "MailingAddressFaxNumber": "541-673-8060",
    "FirstLinePracticeLocationAddress": "1652 NW HUGHWOOD CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEBURG",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97471-8844",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-673-3985",
    "PracticeLocationAddressFaxNumber": "541-673-8060",
    "EnumerationDate": "08/31/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "MFC36003",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "1236LCPC",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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