Provider Demographics
NPI:1154836930
Name:BRANDON HOLLISTER, PH.D., LLC
Entity Type:Organization
Organization Name:BRANDON HOLLISTER, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-460-7282
Mailing Address - Street 1:21410 MCCLELLAN CIR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-6910
Mailing Address - Country:US
Mailing Address - Phone:402-460-7282
Mailing Address - Fax:
Practice Address - Street 1:21410 MCCLELLAN CIR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-6910
Practice Address - Country:US
Practice Address - Phone:402-460-7282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE943261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)