Provider Demographics
NPI:1255515839
Name:HOLLIDAY, MICHELLE YVETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:YVETTE
Last Name:HOLLIDAY
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 1:1010 LAKE ST STE 502A
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1135
Mailing Address - Country:US
Mailing Address - Phone:708-305-0026
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 502A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1135
Practice Address - Country:US
Practice Address - Phone:708-305-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007094103TA0400X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth