MEDICARE: MR. MICHAEL JAN HOLLAND LCPC

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	101YM0800X	Mental Health Counselor	180.009458	IL

General Provider Information

NPI Number	:	1225387590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JAN HOLLAND LCPC

Provider Business Mailing Address
First Line	:	1240 BAMBURG CT
Second Line	:
City	:	HANOVER PARK
State	:	IL
Zip	:	60133-5243
Country	:	US
Telephone Number	:	630-372-6599
Fax Number	:	630-372-6697

Provider Business Practice Location Address
First Line	:	1240 BAMBURG CT
Second Line	:
City	:	HANOVER PARK
State	:	IL
Zip	:	60133-5243
Country	:	US
Telephone Number	:	630-372-6599
Fax Number	:	630-372-6697

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

Provider Enumeration Date	:	09/02/2012
Last Update Date	:	03/09/2016

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