Provider Demographics
NPI:1750252060
Name:HOLLAND, JENNIFER DIANE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13107 SCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-5013
Mailing Address - Country:US
Mailing Address - Phone:405-658-5550
Mailing Address - Fax:405-275-7740
Practice Address - Street 1:1 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6801
Practice Address - Country:US
Practice Address - Phone:405-275-2222
Practice Address - Fax:405-275-7740
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health