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General NPI Number Information
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NPI Number | 1740348259
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Entity Type | Individual
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Provider Name | THOMAS LAWRENCE HOLLOWATY M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 1447 HERBERT AVE SUITE 204
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-8976
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Country | US
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Telephone | 530-307-8554
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Fax |
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Provider Business Mailing Address
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Address Line | 1447 HERBERT AVE SUITE 204
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-8976
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Country | US
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Telephone | 530-307-8554
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Fax |
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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 | MFT13320
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5732-C
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License Number State | NV
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