Active NPI
Charlene Anne Holloway, LMSW
- Mental Health Counselor
- Idaho Falls, ID
National Provider Identifier
1912778895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LMSW44331
- Practice address
- 855 N Capital Ave Ste 1
Idaho Falls, ID 83402-3405 - Phone
- (208) 552-0855
- Fax
- (208) 523-1132
- NPI assigned
- Jan 10, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LMSW44331 | ID | Primary |
Addresses
Primary practice location
855 N Capital Ave Ste 1
Idaho Falls, ID 83402-3405
Mailing address
855 N Capital Ave Ste 1
Idaho Falls, ID 83402-3405
Phone (208) 552-0855
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 |
|---|---|---|---|
| LMSW44331 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704844800000",
"number": "1912778895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "855 N CAPITAL AVE STE 1",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023405",
"telephone_number": "208-552-0855",
"fax_number": "208-523-1132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 N CAPITAL AVE STE 1",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023405",
"telephone_number": "208-552-0855",
"fax_number": "208-523-1132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "CHARLENE",
"middle_name": "ANNE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-10",
"last_updated": "2024-01-10",
"certification_date": "2024-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LMSW44331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.