Provider Demographics
NPI:1265629430
Name:HOLLAND, MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 KING BLVD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3166
Mailing Address - Country:US
Mailing Address - Phone:307-462-4876
Mailing Address - Fax:307-337-3492
Practice Address - Street 1:2435 KING BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3166
Practice Address - Country:US
Practice Address - Phone:307-462-4876
Practice Address - Fax:307-337-3492
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical