Provider Demographics
NPI:1750615001
Name:HOLLADAY, LARI K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LARI
Middle Name:K
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 E LOUISE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5123
Mailing Address - Country:US
Mailing Address - Phone:208-381-2138
Mailing Address - Fax:
Practice Address - Street 1:3330 E LOUISE DR STE 400
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5123
Practice Address - Country:US
Practice Address - Phone:208-381-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-29502104100000X
IDLCSW-326251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker