Provider Demographics
NPI:1811960644
Name:HOLLAND, KERRY L (PHD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 UNIVERSITY PKWY
Mailing Address - Street 2:BOX 70416, ETSU
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-6500
Mailing Address - Country:US
Mailing Address - Phone:423-439-7778
Mailing Address - Fax:423-439-7780
Practice Address - Street 1:807 UNIVERSITY PKWY
Practice Address - Street 2:139 LUCILLE CLEMENT HALL
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-6500
Practice Address - Country:US
Practice Address - Phone:423-439-7778
Practice Address - Fax:423-439-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3981928Medicare ID - Type Unspecified