Provider Demographics
NPI:1083742100
Name:O'LOAN, HOLLY (MS, LPP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:O'LOAN
Suffix:
Gender:F
Credentials:MS, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 TROTTERS POINTE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1279
Mailing Address - Country:US
Mailing Address - Phone:502-525-4200
Mailing Address - Fax:
Practice Address - Street 1:10303 TROTTERS POINTE DR APT 304
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1279
Practice Address - Country:US
Practice Address - Phone:502-525-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166070103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid