Provider Demographics
NPI:1376001677
Name:PAINE, HOLLY L (LCPC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:PAINE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3446 S IDA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-1558
Mailing Address - Country:US
Mailing Address - Phone:316-285-0857
Mailing Address - Fax:316-330-3985
Practice Address - Street 1:3446 S IDA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-1558
Practice Address - Country:US
Practice Address - Phone:316-285-0857
Practice Address - Fax:316-330-3985
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional