Provider Demographics
NPI:1942276191
Name:HOLLAND, BRENDA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:K
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GRAND AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2017
Mailing Address - Country:US
Mailing Address - Phone:970-874-0875
Mailing Address - Fax:970-874-5443
Practice Address - Street 1:115 GRAND AVE
Practice Address - Street 2:STE 1
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2017
Practice Address - Country:US
Practice Address - Phone:970-874-0875
Practice Address - Fax:970-874-5443
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3712103TA0400X
CO1490103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808901OtherMEDICARE PTAN FOR BRENDA K HOLLAND PSYCHOLOGIST
COC808902OtherMEDICARE B PTAN FOR WESTERN SLOPE INNERCHANGE
P01641917OtherRAILROAD WORKERS MEDICARE FOR ALL AMERICAN FAMILIES
CO035354OtherVALUE OPTIONS
CO486918ZUFPOtherMEDICARE B PTAN FOR ALL AMERICAN FAMILIES
CO07014905Medicaid
CO035354OtherVALUE OPTIONS