Active NPI
Andrew Holler
- Addiction (Substance Use Disorder) Counselor
- Fullerton, CA
National Provider Identifier
1154835635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 10774
- Practice address
- 771 W Orangethorpe Ave
Fullerton, CA 92832-2806 - Phone
- (714) 879-0929
- Fax
- (714) 578-2960
- NPI assigned
- Nov 20, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 10774 | CA | Primary |
Addresses
Primary practice location
771 W Orangethorpe Ave
Fullerton, CA 92832-2806
Mailing address
18 Alba E
Irvine, CA 92620-1901
Phone (949) 355-6377
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 |
|---|---|---|---|
| 10774 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hope House Corporation | Past | Accepting new patients | |
| Woodglen Recovery Junction Incorporated | Past | Accepting new patients | |
| Woodglen West Detox | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Anaheim, CA
- NPI 1578646469
-
- Substance Abuse Rehabilitation Facility
- Fullerton, CA
- NPI 1437244159
-
- Substance Abuse Rehabilitation Facility
- Fullerton, CA
- NPI 1093268849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1154835635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 ALBA E",
"city": "IRVINE",
"state": "CA",
"postal_code": "926201901",
"telephone_number": "949-355-6377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "771 W ORANGETHORPE AVE",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928322806",
"telephone_number": "714-879-0929",
"fax_number": "714-578-2960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLER",
"first_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-20",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "10774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.