=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295065506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM CHAD HOLLAND MFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2010
-----------------------------------------------------
Last Update Date | 01/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1614 CONTINENTAL ST STE B
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-241-5999
-----------------------------------------------------
Fax | 530-241-6541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4217 N OLD STAGE RD
-----------------------------------------------------
City | MOUNT SHASTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96067-9131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-949-9094
-----------------------------------------------------
Fax | 530-241-6541
-----------------------------------------------------
=====================================================
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 | MFT47764
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------