Provider Demographics
NPI:1760846901
Name:HOLOHAN, MELISANDE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISANDE
Middle Name:
Last Name:HOLOHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6066 S IOLA WAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5705
Mailing Address - Country:US
Mailing Address - Phone:510-325-4402
Mailing Address - Fax:
Practice Address - Street 1:6066 S IOLA WAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5705
Practice Address - Country:US
Practice Address - Phone:510-325-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist