Provider Demographics
NPI:1003331877
Name:HOMAN, HOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HOMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4696 W CHERT DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-6300
Mailing Address - Country:US
Mailing Address - Phone:317-734-8859
Mailing Address - Fax:
Practice Address - Street 1:802 MULBERRY ST STE DB-04
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3409
Practice Address - Country:US
Practice Address - Phone:317-734-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007764A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty