Provider Demographics
NPI:1306277702
Name:HOLL, BRADFORD (LPC)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:HOLL
Suffix:
Gender:M
Credentials:LPC
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 67
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0067
Mailing Address - Country:US
Mailing Address - Phone:907-351-9220
Mailing Address - Fax:907-373-9220
Practice Address - Street 1:1261 S SEWARD MERIDIAN PKWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8372
Practice Address - Country:US
Practice Address - Phone:907-351-9220
Practice Address - Fax:907-373-9220
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health