Provider Demographics
NPI:1043612112
Name:ROCKETT, HOLLY LYNN (MBA, MFT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:MBA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26079 LUPIN RD
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:CA
Mailing Address - Zip Code:95689-9783
Mailing Address - Country:US
Mailing Address - Phone:209-304-6224
Mailing Address - Fax:
Practice Address - Street 1:26079 LUPIN RD
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:CA
Practice Address - Zip Code:95689-9783
Practice Address - Country:US
Practice Address - Phone:209-650-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist