Provider Demographics
NPI:1558955518
Name:HOLLIHAN, COLLIN ANTHONY
Entity type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:ANTHONY
Last Name:HOLLIHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N DEARBORN ST SPC 30
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3946
Mailing Address - Country:US
Mailing Address - Phone:909-747-8760
Mailing Address - Fax:
Practice Address - Street 1:1301 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2910
Practice Address - Country:US
Practice Address - Phone:833-574-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst