Provider Demographics
NPI:1912478108
Name:HOLLAND, JASON (PHD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PUBLIC SQ STE 105
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3204
Mailing Address - Country:US
Mailing Address - Phone:615-675-0025
Mailing Address - Fax:615-675-0026
Practice Address - Street 1:106 PUBLIC SQ STE 105
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-675-0025
Practice Address - Fax:615-675-0026
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3590103TA0700X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic