MEDICARE: KELLI NICOLE HOLLOWAY LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1720598295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI NICOLE HOLLOWAY LCSW

Provider Business Mailing Address
First Line	:	4844 BLOOMFIELD DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3356
Country	:	US
Telephone Number	:	901-215-8602
Fax Number	:	877-353-0135

Provider Business Practice Location Address
First Line	:	4844 BLOOMFIELD DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3356
Country	:	US
Telephone Number	:	901-215-8602
Fax Number	:	877-353-0135

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

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	04/30/2026

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