Provider Demographics
NPI:1699376517
Name:HOLLOWAY, TAYLOR (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2210
Mailing Address - Country:US
Mailing Address - Phone:618-937-6483
Mailing Address - Fax:
Practice Address - Street 1:403 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-2042
Practice Address - Country:US
Practice Address - Phone:855-608-3560
Practice Address - Fax:618-956-9349
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490248131041C0700X
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2970Medicaid