Individual provider Active NPI

Andrew Holler

  • Addiction (Substance Use Disorder) Counselor
  • Fullerton, CA
National Provider Identifier
1154835635
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
10774 Issued in CA
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

Updated by the provider on Jun 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
10774CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Hope House Corporation Past Accepting new patients
Woodglen Recovery Junction Incorporated PastSince Jun 22, 2021 Accepting new patients
Woodglen West Detox PastSince Jun 22, 2021 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.

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.

Verify at the official NPI Registry.