Provider Demographics
NPI:1720392863
Name:HOLLIS, NELA JOY (MS SE)
Entity Type:Individual
Prefix:MRS
First Name:NELA
Middle Name:JOY
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MS SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2607
Mailing Address - Country:US
Mailing Address - Phone:208-452-7190
Mailing Address - Fax:208-452-5819
Practice Address - Street 1:620 S IDAHO AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2607
Practice Address - Country:US
Practice Address - Phone:208-452-7190
Practice Address - Fax:208-452-5819
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor