Provider Demographics
NPI:1902814221
Name:HOLLAND, ERNEST (LMFT, LMSW)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:LMFT, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 E BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2911
Mailing Address - Country:US
Mailing Address - Phone:505-396-2143
Mailing Address - Fax:
Practice Address - Street 1:920 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5529
Practice Address - Country:US
Practice Address - Phone:505-393-3168
Practice Address - Fax:505-397-4659
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08161041C0700X
NM2517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00046300Medicaid
NM00JM88OtherBLUE CROSS BLUE SHIELD