Provider Demographics
NPI:1467514752
Name:HOLLOMON, JAMES MARTIN (JD, MFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARTIN
Last Name:HOLLOMON
Suffix:
Gender:M
Credentials:JD, MFT
Other - Prefix:MR
Other - First Name:JAMIE
Other - Middle Name:MARTIN
Other - Last Name:HOLLOMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JD, MFT
Mailing Address - Street 1:446 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3644
Mailing Address - Country:US
Mailing Address - Phone:831-454-8178
Mailing Address - Fax:
Practice Address - Street 1:157 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4200
Practice Address - Country:US
Practice Address - Phone:831-454-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37788106H00000X, 225C00000X, 101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator