Provider Demographics
NPI:1083113567
Name:HOLLOWAY, TERESA (LMFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-9621
Mailing Address - Country:US
Mailing Address - Phone:620-441-1420
Mailing Address - Fax:
Practice Address - Street 1:1809 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-4935
Practice Address - Country:US
Practice Address - Phone:620-402-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty