Provider Demographics
NPI:1023057791
Name:HOLLER, MICHAEL G (LMHC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:HOLLER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 PIRATES DR
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2321
Mailing Address - Country:US
Mailing Address - Phone:305-393-1230
Mailing Address - Fax:305-853-1253
Practice Address - Street 1:92330 OVERSEAS HWY STE 103
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2700
Practice Address - Country:US
Practice Address - Phone:305-393-1230
Practice Address - Fax:305-852-7479
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0027671041C0700X
FLMH3670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical