Provider Demographics
NPI:1225267149
Name:HOLLIS MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:HOLLIS MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:208-452-7190
Mailing Address - Street 1:620 S IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2607
Mailing Address - Country:US
Mailing Address - Phone:208-452-7190
Mailing Address - Fax:208-452-5819
Practice Address - Street 1:620 S IDAHO AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2607
Practice Address - Country:US
Practice Address - Phone:208-452-7190
Practice Address - Fax:208-452-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202138251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services