Active NPI
Kraneisha Renee Holloway, LAC
- Professional Counselor
- Mesa, AZ
National Provider Identifier
1023610557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LAC17711
- Practice address
- 4330 E University Dr
Mesa, AZ 85205-7004 - Phone
- (480) 296-3546
- NPI assigned
- Nov 10, 2020
- Last updated
- Nov 10, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LAC17711 | AZ | Primary |
Addresses
Primary practice location
4330 E University Dr
Mesa, AZ 85205-7004
Mailing address
2022 N Navada St
1213
Chandler, AZ 85226
Phone (480) 487-9098
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LAC17711 | Other | AZ | LAC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC17711 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1023610557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2022 N NAVADA ST",
"address_2": "1213",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "85226",
"telephone_number": "480-487-9098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4330 E UNIVERSITY DR",
"city": "MESA",
"state": "AZ",
"postal_code": "852057004",
"telephone_number": "480-296-3546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "KRANEISHA",
"middle_name": "RENEE",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-10",
"last_updated": "2020-11-10",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LAC17711",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LAC",
"identifier": "LAC17711",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.