Provider Demographics
NPI:1669545521
Name:HOLLRAH, SUZANNE LOUISE (MFT INTERN)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LOUISE
Last Name:HOLLRAH
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ALDEBARAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1114
Mailing Address - Country:US
Mailing Address - Phone:805-733-2778
Mailing Address - Fax:
Practice Address - Street 1:315 W HALEY ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-8052
Practice Address - Country:US
Practice Address - Phone:805-966-3310
Practice Address - Fax:805-966-5582
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36822101YM0800X
CA127342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health