1679796189 NPI number — MRS. ANDREA DAWN HOLLEY MSW, LCSW

Table of content: MRS. ANDREA DAWN HOLLEY MSW, LCSW (NPI 1679796189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679796189 NPI number — MRS. ANDREA DAWN HOLLEY MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLEY
Provider First Name:
ANDREA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLF
Provider Other First Name:
ANDREA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA, BHRS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679796189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2402 TANGLEWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUGO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74743-8507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-372-0933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2402 TANGLEWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74743-8507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-372-0933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4060 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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