Provider Demographics
NPI:1669840856
Name:COELHO-HOLM, DYLLAN NICOLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DYLLAN
Middle Name:NICOLE
Last Name:COELHO-HOLM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DYLLAN
Other - Middle Name:NICOLE
Other - Last Name:COELHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1375 E GRAND AVE # 103-301
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2421
Mailing Address - Country:US
Mailing Address - Phone:805-874-0405
Mailing Address - Fax:
Practice Address - Street 1:1375 E GRAND AVE # 103-301
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2421
Practice Address - Country:US
Practice Address - Phone:805-874-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT-INTERN-96108106H00000X
390200000X
CA116665106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program