Provider Demographics
NPI:1851648430
Name:HOLLIS, MIYISHA (MS,MFT-I, CADC-I)
Entity Type:Individual
Prefix:MRS
First Name:MIYISHA
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MS,MFT-I, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 FALL HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-3790
Mailing Address - Country:US
Mailing Address - Phone:702-506-2661
Mailing Address - Fax:
Practice Address - Street 1:2923 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1925
Practice Address - Country:US
Practice Address - Phone:702-463-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01170-I101YA0400X
NVMI1087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)