Provider Demographics
NPI:1740348259
Name:HOLLOWATY, THOMAS LAWRENCE (MSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:HOLLOWATY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 HERBERT AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8976
Mailing Address - Country:US
Mailing Address - Phone:530-307-8554
Mailing Address - Fax:
Practice Address - Street 1:1447 HERBERT AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8976
Practice Address - Country:US
Practice Address - Phone:530-307-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT13320106H00000X
NV5732-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS015720Medicaid