Provider Demographics
NPI:1427708866
Name:HOLLOWAY, DARYL ELIZABETH (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:ELIZABETH
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4633 EWING AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1432
Mailing Address - Country:US
Mailing Address - Phone:952-356-7466
Mailing Address - Fax:
Practice Address - Street 1:4500 PARK GLEN RD STE 450
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5190
Practice Address - Country:US
Practice Address - Phone:952-444-9744
Practice Address - Fax:952-444-9745
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical