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NPI Code Detail

MEDICARE: SARA HOLLY LPC, CSAC

MEDICARE: SARA HOLLY LPC, CSAC
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
1101YP2500XProfessional Counselor6436-125WI
2101YA0400XAddiction (Substance Use Disorder) Counselor16036-132WI

General Provider Information

NPI Number : 1780015131
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA HOLLY LPC, CSAC
Provider Business Mailing Address
First Line : 925 E HAMILTON ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1528
Country : US
Telephone Number : 414-331-5824
Fax Number :
Provider Business Practice Location Address
First Line : 535 N 39TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-3746
Country : US
Telephone Number : 414-962-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2013
Last Update Date : 05/07/2026

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