Provider Demographics
NPI:1225387590
Name:HOLLAND, MICHAEL JAN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAN
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1240 BAMBURG CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5243
Mailing Address - Country:US
Mailing Address - Phone:630-372-6599
Mailing Address - Fax:630-372-6697
Practice Address - Street 1:1240 BAMBURG CT
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5243
Practice Address - Country:US
Practice Address - Phone:630-372-6599
Practice Address - Fax:630-372-6697
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health