Provider Demographics
NPI:1649825977
Name:HOLLAND, MELINDA M (LSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RB CONTRACTING LN
Mailing Address - Street 2:
Mailing Address - City:CURWENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16833-7148
Mailing Address - Country:US
Mailing Address - Phone:814-592-5127
Mailing Address - Fax:
Practice Address - Street 1:60 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-6016
Practice Address - Country:US
Practice Address - Phone:814-765-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135980101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health