Amanda Holly, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071-007489 Issued in IL

Practice address

9855 Woods Dr
Suite G105
Skokie, IL 60077-1074

Phone

(847) 966-9343

Fax

(847) 966-9563

NPI assigned

Jun 16, 2011

Last updated

Jun 16, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 7, 2017 through Jul 7, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chicago Cognitive Behavioral Treatment Center

  • Clinical Psychologist
  • Skokie, IL
  • NPI 1457676322
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308182400000",
    "number": "1922393099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9855 WOODS DR",
            "address_2": "SUITE G105",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771074",
            "telephone_number": "847-966-9343",
            "fax_number": "847-966-9563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9855 WOODS DR",
            "address_2": "SUITE G105",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771074",
            "telephone_number": "847-966-9343",
            "fax_number": "847-966-9563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLY",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-007489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holistic Wellness Chicago LLC
• Amanda Jill Holleb, PA-C
• Susan P Holler
• Kirsten Hollett, MD
• Christopher Bryan Holloway
• Linda Holt
• Home and Wound Care Physicians PC
• Home Bound Eye Care Services LTD
• Home Health Choice, Inc.
• Home Patient Services, Inc

• Psychologist in Skokie, IL
• Providers in Skokie, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.