Provider Demographics
NPI:1235882788
Name:HOLLIE, BRANDON (AMFT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HOLLIE
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 W 18TH ST UNIT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1944
Mailing Address - Country:US
Mailing Address - Phone:515-509-8472
Mailing Address - Fax:
Practice Address - Street 1:137 N OAK PARK AVE STE 329
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1375
Practice Address - Country:US
Practice Address - Phone:773-340-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist