Provider Demographics
NPI:1407029291
Name:HOLLE, AMY IONE (MFT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:IONE
Last Name:HOLLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 OLEMA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1339
Mailing Address - Country:US
Mailing Address - Phone:415-847-3112
Mailing Address - Fax:
Practice Address - Street 1:351 OLEMA RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1339
Practice Address - Country:US
Practice Address - Phone:415-847-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist