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NPI Code Detail

MEDICARE: DR. MARY LOU HOLLIS ED.D.

MEDICARE: DR. MARY LOU HOLLIS ED.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6301002452MI
2106H00000XMarriage & Family Therapist4101005257MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OC945940OTHERMIBCBSM
2007039OTHERMIVALUEOPTIONS

General Provider Information

NPI Number : 1013914274
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY LOU HOLLIS ED.D.
Provider Business Mailing Address
First Line : 5464 HOLIDAY TER
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2147
Country : US
Telephone Number : 269-372-1940
Fax Number : 269-349-5105
Provider Business Practice Location Address
First Line : 5464 HOLIDAY TER
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2147
Country : US
Telephone Number : 269-372-1940
Fax Number : 269-349-5105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2005
Last Update Date : 09/11/2025

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