Provider Demographics
NPI:1437524980
Name:HOLLINS, NATASHA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:HOLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S ALAMO BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4259
Mailing Address - Country:US
Mailing Address - Phone:903-431-1562
Mailing Address - Fax:
Practice Address - Street 1:202 S ALAMO BLVD
Practice Address - Street 2:STE A
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4259
Practice Address - Country:US
Practice Address - Phone:903-431-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X
TX001101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX475476754Medicaid