Provider Demographics
NPI:1215585500
Name:HOLLOWAY, JENNIFER NOWELL (LMFT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NOWELL
Last Name:HOLLOWAY
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15270 N BROOKSIDE LN
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2449
Mailing Address - Country:US
Mailing Address - Phone:757-784-2384
Mailing Address - Fax:602-887-1494
Practice Address - Street 1:15270 N BROOKSIDE LN
Practice Address - Street 2:SUITE 121
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2449
Practice Address - Country:US
Practice Address - Phone:757-784-2384
Practice Address - Fax:602-887-1494
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15366101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health