Provider Demographics
NPI:1528049392
Name:HOLLIS, SARA (PSYD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736E SUNSHINE ST 811
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1334
Mailing Address - Country:US
Mailing Address - Phone:417-882-4485
Mailing Address - Fax:417-882-5517
Practice Address - Street 1:1736E SUNSHINE ST 811
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1334
Practice Address - Country:US
Practice Address - Phone:417-882-4485
Practice Address - Fax:417-882-5517
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO464393OtherVALUEOPTIONS
MO203760OtherMANAGED HEALTH NETWORK
MO18803OtherNEW DIRECTIONS
MO7489134OtherAETNA
MO118660OtherBLUE CROSS BLUE SHIELD