Provider Demographics
NPI:1225372485
Name:SCOGGINS, HOLLY L
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:L
Last Name:SCOGGINS
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 1:2100 S HAYNIE CT
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-3540
Mailing Address - Country:US
Mailing Address - Phone:918-798-5218
Mailing Address - Fax:
Practice Address - Street 1:2100 S HAYNIE CT
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3540
Practice Address - Country:US
Practice Address - Phone:918-798-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health