MEDICARE: MISS SHAINA CHARLINE HOLDERNESS M.A.

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	101YP2500X	Professional Counselor	LPC0014242	CO

General Provider Information

NPI Number	:	1184985780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHAINA CHARLINE HOLDERNESS M.A.

Provider Business Mailing Address
First Line	:	899 N LOGAN ST STE 406
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3155
Country	:	US
Telephone Number	:	720-515-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 N LOGAN ST STE 406
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3155
Country	:	US
Telephone Number	:	720-515-7423
Fax Number	:

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

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	03/17/2018

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