Provider Demographics
NPI:1124130158
Name:KADESH, HOLLIS HOLLY (LPC)
Entity type:Individual
Prefix:MS
First Name:HOLLIS
Middle Name:HOLLY
Last Name:KADESH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:KADESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 S PARK CT
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8121
Mailing Address - Country:US
Mailing Address - Phone:406-671-4772
Mailing Address - Fax:541-673-8060
Practice Address - Street 1:1652 NW HUGHWOOD CT
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8844
Practice Address - Country:US
Practice Address - Phone:541-673-3985
Practice Address - Fax:541-673-8060
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36003106H00000X
MT1236LCPC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500856906Medicaid
MT0257193Medicaid