Provider Demographics
NPI:1093483372
Name:HOLLOWAY, DEVON CHERE (LPC)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:CHERE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:CHERE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 TAMARACK TRL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-3184
Mailing Address - Country:US
Mailing Address - Phone:208-880-2965
Mailing Address - Fax:
Practice Address - Street 1:8601 W EMERALD ST STE 130
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8209
Practice Address - Country:US
Practice Address - Phone:208-600-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional