Provider Demographics
NPI:1295065506
Name:HOLLAND, WILLIAM CHAD (MFT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHAD
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 N OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9131
Mailing Address - Country:US
Mailing Address - Phone:530-949-9094
Mailing Address - Fax:530-241-6541
Practice Address - Street 1:1614 CONTINENTAL ST STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1121
Practice Address - Country:US
Practice Address - Phone:530-241-5999
Practice Address - Fax:530-241-6541
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT47764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist