Provider Demographics
NPI:1215362223
Name:HOLLY T MITCHELL PLLC
Entity Type:Organization
Organization Name:HOLLY T MITCHELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:TABITHA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-552-5559
Mailing Address - Street 1:713 W BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9147
Mailing Address - Country:US
Mailing Address - Phone:972-552-5559
Mailing Address - Fax:972-552-5499
Practice Address - Street 1:713 W BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9147
Practice Address - Country:US
Practice Address - Phone:972-552-5559
Practice Address - Fax:972-552-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty