Provider Demographics
NPI:1417711748
Name:HOLLAND, ASPEN (MA)
Entity type:Individual
Prefix:
First Name:ASPEN
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 W DITCH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6186
Mailing Address - Country:US
Mailing Address - Phone:971-255-2256
Mailing Address - Fax:
Practice Address - Street 1:1510 W USTICK RD STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7740
Practice Address - Country:US
Practice Address - Phone:971-255-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health