Provider Demographics
NPI:1275893695
Name:HARRISON, HOLLY (MA, LMFT, CRAADC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MA, LMFT, CRAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 W CHESTERFIELD BLVD
Mailing Address - Street 2:SUITE E202
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8650
Mailing Address - Country:US
Mailing Address - Phone:417-881-8890
Mailing Address - Fax:417-881-4249
Practice Address - Street 1:2146 W CHESTERFIELD BLVD
Practice Address - Street 2:SUITE E202
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8650
Practice Address - Country:US
Practice Address - Phone:417-881-8890
Practice Address - Fax:417-881-4249
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011040291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist