Provider Demographics
NPI:1376902346
Name:REILLY, HOLLY (TLMFT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-0416
Mailing Address - Country:US
Mailing Address - Phone:515-465-5739
Mailing Address - Fax:515-465-5744
Practice Address - Street 1:105 S VINE ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3164
Practice Address - Country:US
Practice Address - Phone:641-683-5993
Practice Address - Fax:641-684-4826
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist