Provider Demographics
NPI:1245586999
Name:WALLRAFF, HOLLY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:WALLRAFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 HEATHER LN APT A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4878
Mailing Address - Country:US
Mailing Address - Phone:309-574-0014
Mailing Address - Fax:
Practice Address - Street 1:1612 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3660
Practice Address - Country:US
Practice Address - Phone:309-574-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical