Provider Demographics
NPI:1811537376
Name:HOLLISTER, DEIDRE (LMSW, LIMHP, LMHP)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:LMSW, LIMHP, LMHP
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3710 CENTRAL AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8126
Mailing Address - Country:US
Mailing Address - Phone:402-796-1717
Mailing Address - Fax:844-909-4769
Practice Address - Street 1:3710 CENTRAL AVE STE 4
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8126
Practice Address - Country:US
Practice Address - Phone:402-796-1717
Practice Address - Fax:844-909-4769
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5248101YM0800X
NE18031041C0700X
NE3131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical