Provider Demographics
NPI:1073536488
Name:HOLLERAN, THERESA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:HOLLERAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:A
Other - Last Name:HOLLERAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:150 S 600 E STE 7C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1989
Mailing Address - Country:US
Mailing Address - Phone:801-524-0560
Mailing Address - Fax:801-364-2585
Practice Address - Street 1:150 S 600 E STE 7C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1989
Practice Address - Country:US
Practice Address - Phone:801-524-0560
Practice Address - Fax:801-364-2585
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12006735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical