Provider Demographics
NPI:1235341801
Name:HOLLIST, CODY STONEWALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:STONEWALL
Last Name:HOLLIST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1421
Mailing Address - Country:US
Mailing Address - Phone:402-438-5330
Mailing Address - Fax:
Practice Address - Street 1:2111 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1421
Practice Address - Country:US
Practice Address - Phone:402-438-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist