Provider Demographics
NPI:1376958199
Name:HOLLAND, GLORIA TEMPLE (MA, LSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:TEMPLE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, LSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 OLD PLANTERS RD
Mailing Address - Street 2:
Mailing Address - City:PLANTERSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38862-6200
Mailing Address - Country:US
Mailing Address - Phone:662-377-2865
Mailing Address - Fax:662-377-2844
Practice Address - Street 1:4579 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6539
Practice Address - Country:US
Practice Address - Phone:662-377-2865
Practice Address - Fax:662-377-2844
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW0111104100000X
MST0068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker