Provider Demographics
NPI:1356777528
Name:HOLLAND, RUTH ANN
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 BROWNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-9104
Mailing Address - Country:US
Mailing Address - Phone:402-749-0646
Mailing Address - Fax:855-551-4086
Practice Address - Street 1:1144 BROWNFIELD RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-9104
Practice Address - Country:US
Practice Address - Phone:402-749-0646
Practice Address - Fax:855-551-4086
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health