Provider Demographics
NPI:1235383787
Name:MAUGHN, HOLLY MICHELLE (BA)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:MICHELLE
Last Name:MAUGHN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 E. COLORADO BLVD, 8TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-229-3818
Mailing Address - Fax:626-793-6003
Practice Address - Street 1:532 E COLORADO BLVD FL 8
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2044
Practice Address - Country:US
Practice Address - Phone:626-229-3818
Practice Address - Fax:626-793-6003
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health