Provider Demographics
NPI:1215082979
Name:HOLLAND, JANE ALICE (LMHC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ALICE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX KK
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1570
Mailing Address - Country:US
Mailing Address - Phone:505-751-7037
Mailing Address - Fax:505-751-3010
Practice Address - Street 1:314 DON FERNANDO ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5953
Practice Address - Country:US
Practice Address - Phone:505-751-7037
Practice Address - Fax:505-751-3010
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0098661101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor