MEDICARE: DR. JAMI LEE HOLLER PSY.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
1	106H00000X	Marriage & Family Therapist	MFT 37120	CA

General Provider Information

NPI Number	:	1093796013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMI LEE HOLLER PSY.D.

Provider Business Mailing Address
First Line	:	4524 BABICH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-1907
Country	:	US
Telephone Number	:	916-457-2234
Fax Number	:	916-444-6054

Provider Business Practice Location Address
First Line	:	1990 3RD ST
Second Line	:	SUITE 600
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-6929
Country	:	US
Telephone Number	:	916-457-2234
Fax Number	:	916-444-6054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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