Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | IL | |
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL | |
N | 103TH0004X | Health Psychologist | IL |
NPI | 1255515839 |
---|---|
Provider Name | Dr. Michelle Yvette Holliday |
First Address | Oak Park, IL 60301-1147 |
Second Address | Oak Park, IL 60301-1147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |