MEDICARE: DR. JUDITH SHIELDS HOLLAND PH.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	103TC0700X	Clinical Psychologist	3232	CO

General Provider Information

NPI Number	:	1194977736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH SHIELDS HOLLAND PH.D.

Provider Business Mailing Address
First Line	:	1385 S COLORADO BLVD
Second Line	:	SUITE 210
City	:	DENVER
State	:	CO
Zip	:	80222-3304
Country	:	US
Telephone Number	:	303-639-5240
Fax Number	:	303-639-5243

Provider Business Practice Location Address
First Line	:	1385 S COLORADO BLVD
Second Line	:	SUITE 210
City	:	DENVER
State	:	CO
Zip	:	80222-3304
Country	:	US
Telephone Number	:	303-639-5240
Fax Number	:	303-639-5243

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

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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