Provider Demographics
NPI:1225171481
Name:KENDRICK, HOLLEY
Entity Type:Individual
Prefix:
First Name:HOLLEY
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 N LOOP 1604 E
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1711
Mailing Address - Country:US
Mailing Address - Phone:210-495-2117
Mailing Address - Fax:888-892-4363
Practice Address - Street 1:2838 N LOOP 1604 E
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1711
Practice Address - Country:US
Practice Address - Phone:210-495-2117
Practice Address - Fax:888-893-4363
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX11476101YA0400X
TX69136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)