Provider Demographics
NPI:1851583272
Name:HOLLISTER, CLINTON DOYLE (MFT)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:DOYLE
Last Name:HOLLISTER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 PASO ROBLES DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1062
Mailing Address - Country:US
Mailing Address - Phone:805-969-9745
Mailing Address - Fax:805-969-6806
Practice Address - Street 1:490 PASO ROBLES DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1062
Practice Address - Country:US
Practice Address - Phone:805-969-9745
Practice Address - Fax:805-969-6806
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM14705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist