1942276191 NPI number — DR. BRENDA K HOLLAND PHD

Table of content: DR. BRENDA K HOLLAND PHD (NPI 1942276191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942276191 NPI number — DR. BRENDA K HOLLAND PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
BRENDA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942276191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 GRAND AVE
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
DELTA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81416-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-874-0875
Provider Business Mailing Address Fax Number:
970-874-5443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 GRAND AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
DELTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81416-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-874-0875
Provider Business Practice Location Address Fax Number:
970-874-5443
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TA0400X , with the licence number:  3712 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 1490 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C808901 . This is a "MEDICARE PTAN FOR BRENDA K HOLLAND PSYCHOLOGIST" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: C808902 . This is a "MEDICARE B PTAN FOR WESTERN SLOPE INNERCHANGE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: P01641917 . This is a "RAILROAD WORKERS MEDICARE FOR ALL AMERICAN FAMILIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 035354 . This is a "VALUE OPTIONS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 486918ZUFP . This is a "MEDICARE B PTAN FOR ALL AMERICAN FAMILIES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 07014905 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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