Provider Demographics
NPI:1467280719
Name:HOLLADAY, NATHAN S (AMFT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:S
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FOOTHILL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-4579
Mailing Address - Country:US
Mailing Address - Phone:818-446-7488
Mailing Address - Fax:
Practice Address - Street 1:2600 FOOTHILL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-4579
Practice Address - Country:US
Practice Address - Phone:818-446-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT131618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist