Provider Demographics
NPI:1326361353
Name:SOUDER, HOLLY GRIMM (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:GRIMM
Last Name:SOUDER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N PENELOPE ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2675
Mailing Address - Country:US
Mailing Address - Phone:254-933-3306
Mailing Address - Fax:
Practice Address - Street 1:515 N PENELOPE ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2675
Practice Address - Country:US
Practice Address - Phone:254-933-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health