Provider Demographics
NPI:1073066486
Name:BENNINGFIELD, HOLLY (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BENNINGFIELD
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MCMURTRY AVE
Mailing Address - Street 2:STE. 107
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1634
Mailing Address - Country:US
Mailing Address - Phone:270-298-3461
Mailing Address - Fax:
Practice Address - Street 1:112 E MCMURTRY AVE
Practice Address - Street 2:STE. 107
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1634
Practice Address - Country:US
Practice Address - Phone:270-298-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health