MEDICARE: MR. THOMAS LAWRENCE HOLLOWATY M.S.W.

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	MFT13320	CA
2	1041C0700X	Clinical Social Worker	5732-C	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740348259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS LAWRENCE HOLLOWATY M.S.W.

Provider Business Mailing Address
First Line	:	1447 HERBERT AVE
Second Line	:	SUITE 204
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-8976
Country	:	US
Telephone Number	:	530-307-8554
Fax Number	:

Provider Business Practice Location Address
First Line	:	1447 HERBERT AVE
Second Line	:	SUITE 204
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-8976
Country	:	US
Telephone Number	:	530-307-8554
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/09/2010

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