Provider Demographics
NPI:1396018131
Name:TINDER, HOLLI K (MS, LCPC, CAADC)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:K
Last Name:TINDER
Suffix:
Gender:F
Credentials:MS, LCPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 S BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2624
Mailing Address - Country:US
Mailing Address - Phone:608-247-1520
Mailing Address - Fax:
Practice Address - Street 1:2000 E RACINE ST STE 120
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-4300
Practice Address - Country:US
Practice Address - Phone:608-247-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-007556101YP2500X
IL180008756101YP2500X
WI15854-132101YA0400X
WI5190-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396018131Medicaid