Provider Demographics
NPI:1780291484
Name:HOLLIDAY, R DIANE (MA, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:R
Middle Name:DIANE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 BLUEGRASS WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6009
Mailing Address - Country:US
Mailing Address - Phone:970-231-2856
Mailing Address - Fax:
Practice Address - Street 1:503 REMINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3089
Practice Address - Country:US
Practice Address - Phone:970-658-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health