Provider Demographics
NPI:1073342648
Name:HOLERUD, MADISON (TLMHC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HOLERUD
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1501
Mailing Address - Country:US
Mailing Address - Phone:319-558-8214
Mailing Address - Fax:
Practice Address - Street 1:308 1ST AVE W
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:IA
Practice Address - Zip Code:52033-7721
Practice Address - Country:US
Practice Address - Phone:319-224-0722
Practice Address - Fax:877-728-2951
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health