Provider Demographics
NPI:1265650006
Name:TOWERS, HOLLY S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:S
Last Name:TOWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:S
Other - Last Name:DEBOARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:501 E. 15TH
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-216-5240
Mailing Address - Fax:405-285-0294
Practice Address - Street 1:501 E. 15TH, SUITE 400A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-216-5240
Practice Address - Fax:405-285-0294
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3289104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
24220430Medicare PIN