Provider Demographics
NPI:1275154304
Name:HOLLY F NGUYEN THERAPY LLC
Entity Type:Organization
Organization Name:HOLLY F NGUYEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:FORSTER-NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-701-9333
Mailing Address - Street 1:1901 N MOORE AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3612
Mailing Address - Country:US
Mailing Address - Phone:405-701-9333
Mailing Address - Fax:
Practice Address - Street 1:1901 N MOORE AVE STE 15
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3612
Practice Address - Country:US
Practice Address - Phone:405-701-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty