Provider Demographics
NPI:1881841708
Name:HOLLAND, DANIEL C (PHD, MPH, ABPP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PHD, MPH, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 DUNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1536
Mailing Address - Country:US
Mailing Address - Phone:952-956-2491
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 301
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:952-956-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009538103G00000X, 103TC0700X
MNLP 5254103TC0700X, 103G00000X, 103TC2200X, 103TM1800X
IL071.005004103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities