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General NPI Number Information
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NPI Number | 1124130158
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Entity Type | Individual
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Provider Name | HOLLIS HOLLY KADESH LPC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1652 NW HUGHWOOD CT
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City | ROSEBURG
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State | OR
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Zip | 97471-8844
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Country | US
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Telephone | 541-673-3985
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Fax | 541-673-8060
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Provider Business Mailing Address
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Address Line | 110 S PARK CT
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City | ROSEBURG
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State | OR
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Zip | 97471-8121
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Country | US
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Telephone | 406-671-4772
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Fax | 541-673-8060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC36003
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1236LCPC
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License Number State | MT
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