Provider Demographics
NPI:1629305586
Name:HOLLO, MATTHEW M (LPCC-S)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:HOLLO
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-1433
Mailing Address - Country:US
Mailing Address - Phone:419-239-2113
Mailing Address - Fax:419-239-2113
Practice Address - Street 1:8081 ADAMS RIDGE RD
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9173
Practice Address - Country:US
Practice Address - Phone:419-239-2113
Practice Address - Fax:419-239-2113
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600346101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157085Medicaid