Provider Demographics
NPI:1306500871
Name:NIELSEN, HOLLY (LMFT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 INDEPENDENCE CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4921
Mailing Address - Country:US
Mailing Address - Phone:530-551-8312
Mailing Address - Fax:
Practice Address - Street 1:60 INDEPENDENCE CIR STE 202
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4921
Practice Address - Country:US
Practice Address - Phone:530-551-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT136702OtherLICENSED MARRIAGE AND FAMILY THERAPIST