Provider Demographics
NPI:1124793351
Name:HOLINER, CAMILLE (PSYD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:HOLINER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 TRAVIS ST APT 12
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7537
Mailing Address - Country:US
Mailing Address - Phone:214-868-0709
Mailing Address - Fax:
Practice Address - Street 1:4060 TRAVIS ST APT 12
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-7537
Practice Address - Country:US
Practice Address - Phone:214-868-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical